Beaton, Margaret Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
£ This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Villa,:e, 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.
Regi, tered No.....2.
Town a
Dist. Nagel/ 1 County Village ��
lty (I ity, give street address)
Nime of deceased
ngle, married, widowed,
S `�Leolor divorced (write the word) �c� c a Date of D th 1 19�'j
Age? Years.... ..1�{,t Mo s 2./ Days Birthplace d4 -
Cause of Death.. , ... � �c.-�- -,-9 rvz‘_..d,r e'e -(ate"`
Certificate was ned by -G-- M.D.
Address
Place of Bu;ial (or Removal) ....?we-tiro. l(If body Is to be temporarily held,fill In space later)
Cemetery.,441.,. ,i44 1" Date of Burial W-44 2 :�- 19 1.?
(If body Is to be temporarily held, till 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_a cepted the same fo registration, have recorded it in my Local Record with the above stated Registered
Numbs d on the is reof I HEREBY GRANT A PERMIT
Nam e (Address)
the to hold temporarily and the body.
. (1 rtal er or pe n h ag charge f corpse) (Inter, e o , o her ise disn e [ how])
Dated. .. rt i� 3 19.36d (Signed) ,. .
Local Registrar
This Permit is su cient for the Removal (and Interment or Cremation) of a body to any part of State (subject to local
cemetery or other regulations), unless removal is by common carrier,in which case a Transit Permit (VS o. 62) is required.
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