Binley, Hattie Form VS.sL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
P• 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DUR LE BLACK INK. Registered No s7Z....9 P
Town
Dist. No 6OV County.... Village ,/
City (If city, give street address)
Name of deceased
O ///` Single, mardivorced
w the o , 'l �� �/
5e Color or divorced (write the word) (�/ Date of Death... 19.5�
Years 1 Months ' Days irth lace7 7'`
Age _ - '
Cause of Death
Certificate was signed ' ' _ �`I-� .
Address ,...:�,'�i�-�'4-� � �. L.4
Place of Buy ial (or Removal) 7.�Gft-+t�^--
(If body is to be temporarily flll•in sp c ater) �,,I-,, l �/
Cemetery —,-(44-e Date of Burial �''�!' ./•-4 19,7'
(If body is to be temporarily bell,fill 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 SATISFACTORY AS REQUIRED BY LAW.
I have accepted the same for registration, have recorded it in my Local Record with the above state• Registered
Number, a on the b 's the eo �BY GRANT A PERMIT y eee/ e�� X�
to !�/
a � �s)
the to hold temporarily nd the body.
(Undertaker or person baying charge o pse) r, remove,or tberwi -snore of to bow])
Dated '- •- /..3 19..54�or (Signed)... ••- �-
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the St a (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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