Budd, Delmar Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tor This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration Distri (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTI TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. ._.�
e R T(� Town e8rato�a •
Dist. No ( "" County SA tA.TOGA Village .� Springs...Aj.....6r
, a • lty (It efts, st fedt`adafese)
Nam of deceased !�
Single, married, widowed, q
Sex..../.`.7*f.Years
olor.y!�l� ol} divorced (write �hg wo Date of Deat . 19�1
Age of/. nths... .AY. ....D0 irthplace
Cause of Death fx..z.,.....i.L14,44.4.1/1e/e.
Certificate was si ned by .. M.D.
Address... ` .�
! �,
,Place of Buri (, r Remov
(If body is to be e porasily be space 1 ter)
Cemetery.. ..�4. , Date of Buria..17 '�""� /�• 192-''(If body is to be empor ily he , in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SAT FACTORY AS RE UIRED BY LAW,
I have accepted the same for regi tratio , have recorded it in my Lo ecord with abo stated Registered
Number, and on th s' t I BY GRANT A PERMI
to 4r ... ...
me) ( re a
the hold temporarily the body.
(4.61„.....
r or pens ha ngcharge o c ee) (Inter,remove r oth e s e of[state owl)Dated /. 19... }� (Signed)
egistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body part o 1
cemeterj' or other regulations),unless removal is by common carrier, in which case a Tr • Permit S No. 2) is r
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