Patterson, Robert Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
imr 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 alter the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No .,.. 2-7-
C� T / �
Dist.. No l County `�11�4,4. Village ✓ GA- AC
(If city'IV
street address)
Name of dece ed f e
,.......- --.,..
// Slagle, married, wicletived, ���,�
Sep:. .Color e cr ulivuced (write the word) Date of eat 19 /;
Age $6 Year ld 'Month yG Days Birthplace /"'
Cause of Death Ll41.4 '4�-
Certificate was signed bar . -` ‘yi,-... ... M.D.
Address / / ..... ..... ..... .. .... .
Place of Burial (or 4 ) va:) fir,,
C body is to be tempor- �eldlfil ins l z/� ' '/L
Cemetery ..G/r/"".C— Date of Burial 19.!"..1
(If body is to be tempo arily held, 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 acce • the s: for 'stration, have recorded it in my Local Record with .e above stated Registered
Number, an+;..� ;Ps f I Ell E GRANT A PERMIT a �/
to .. :GC�J
the to hold temporarily and. i .II the body.
(Un r o pers having charg orpse) ( nt oe otherwjged f [slat•,Dated 19 (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ( ubject 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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