Albert Sr, John •
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
22r 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. ,�°11
Town
Dist. No kI County ��..�� Village. .
or City (If city, give street address)
Name of deceasedlel.,441- 1.--P":g rmceadrrewdr, wdowedSex.; /4-Color - onindivo iteith wor d),4,
?Z - Date of Death :. ......19f',"
Age 77 Years.... .$' onths At- Days Birthplace
Cause of Death
Certificate was signed by ,/.Q:. M.D.
Address .f�s�`-A. ... T .
Place of Burial (or Remo., . ... . . ...•
--
(If body is to be temp rily held,fill n paee later)
Cemetery ,-. 7�Ge- Date of Burial .dtrs, L Zj. 19.`,Cl...
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been pr ented 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 stated Registered
Numbe and on - Xs ereof I HEREBY GRANT A PERMIT
e) (Addres
the to hold temporarily an ..� ..F..._... . .. ... ..the body.
(Undertaker person baying charge f corpse) `I a remove,or otheys�ise d' a of eta )
Dated. ... ,...j/ 19. .. (Signed) �/
f Local Registrar
This Perm' is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ubject to to al
cemetery or other regulations). unless removal is by common carrier,in which case a Transit Permit (VS No. 62) s required.
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