La Rich, Joseph Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
L 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 DURABLE BLACK INK. Registered No
Dist. Not 6t. . Town
�....County .. .. Village' �!�.IC.e.�C.Arf . . .. .
(If city,give street roes)
Name of deceased
ingle, married, widowed,
Sex.. Color..., or divorced (write the word).. Date f Death.... . l 194,?
Age.. .l) rs 4/• Months. ..9—P Days , Birthplace. ....
Cause of Death.... .. .. . ... .
Certificate was signed by .�L,,.,,2.,R,,�,,,--• M.D.
Address
Place of Burial (or Removal ...
(If body Is to q,e¢por y e , in space later) �(�� �
Cemetery.... Date of Burial taw ::«..r. L-f-- 41-1
(If body is to be temporarily ld, fill in apace later)
The Certificate of Dea h 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 record'-d it in my Lo Record with the above stated Registered
Nu , and on a bail f I HEREBY GRANT A PERMIT `a� •�i . G!
to �i
am ea)
the to hold temporar' and the body.
(IIi ip ak r or pehaving f n charge o c rp■e) ter, , herwise dispose of ■ is bowl)
Dated ./*GiG,... 19..If (Signed). 1, ve
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (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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