Ramsey, Willard Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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
//,CC Town
Dist. No .SL1(1.`�.Coun�a .li't'Sge .G 44
(If city,give st t address)
Nime of deceased .11. r.C. �s>�.�.1� cieV.i ��G'~
--�,��.] Single, married, widowed, gg ��jj rl
Sex olor.,l� or divorced (write the word) 'L.4cJ1h,c,Lt.,n/ Date of Death.... .. .......}. ,P.'S...l......19.. ..o�
Age Years Months D s B'rth ce- t.r.....tQc (..L,...
Cause of Death ..-�,� /
Certificate was signed by - . .A-Rn. "�` 4.A' M '..
Address ~'''
Place of Bui ia1 (or Remo al) •
(If body is to be temporarily hel fill in c 1 er)
Cemetery.. .... Date of Burial 6 ^ 19., .3
(If body is to be temporarily eld,fill in s e later)
The Certificate of Death contains g the above stated part' ulars, 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 ame fj registration, have recorded it in my Local ecord withe above stated Registered
r, apd n th basis`.ereot I HEREBY GRANT A PERMIT
to t Illr ►/' .. ....
a <y�-- Na e) f Address)
the e !(. to hold temporariand the body.
Undertaker or person,having charge f rpse) (I , re , r otherwise dis9 se of[state how])
Dated...... .. .. . . `I 19.. o (Signed) .. .... . ....... ... ..
• Local Registrar
This Permit is sufficient for the Removal (and Interment r r ation f a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier n whi case a Transit Permit (VS No. 62) is required.
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