Burdett, William Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Z This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF t OF
DEATH, LEGIBLY WRITTEN IN DUR BLACK INK. Registered No. ����jj
Z6lR*fr
Dist. Nos '" County.... y .age //
Name of deceased
�Or (If city,give street address)
'Sex ' ic� �e married, widowed,
w. Colo or drin rc'Ed (write the word) Date o2015,) 7f 10
Age ra 9' Years.. / hs 1- 1-' .Days Birthplace 'Y
C..use of Death
Certificate was signed by. .. M.D.
Address
Place of Burial or mova "7"4/74, .::, ,,c----e-o•i--.6-4--%___.
(If body is to be tem Hy hel 11 in apace later)
Cemetery .,,eves- Date of Burial � 19Yt-
(If body is to be temporarily held,till in space later)
The Certificate of Death containing the above stated particulars, having been presented t e, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for re‘;:ti. hay recorded it in my Local Record with the above stated Registered
Number, and y the r- ii' •E: ' GRANT A PERMIT ��to /-` �
0,40
the .. '` to hold temporaril d.. the body.
g charg o 9se) i3""1--""1-)21*,!r
e,o gr erw • e t 1rW])
(Urn er r e on¢1 ' IJ t/'V
Dated f 19 (Signed)... .. ..
Local Registrar
This Permit i sufficient for the Removal (and Interment or Cremation) of a body to any part of the Sta e (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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