Walsh, James Form VS.M. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 WRPITEN IN DURABLE BLACK INK. Registered No. It
Town of Caldwell
Dist. No 56.y1..County Warren
(If city,give street address)
Name of deceased Jose* F... lialeh
Single, married, widowed,
Sex...Y*,1.+...Color..ZZh1,te..or divorced (write the word)....8ingle. Date of zone
.... , 19.43.
Age...6g Years 10 Months 1. Days Birthplace....Ii1�lade...Inland
Cause of Death Ceranar3e...Thronb.ez.ia
.. . ..Bur
-Certificate was signed by -,_� S tie®r��,,.'.. �
Address • _Y Y.
t
Place of Burial (or Removal) Pine..Yiew...Gen.e.tery Tesn..si...Qusenbury
(If body is to be temporarily held,fill in space later)
Cemetery Date of Burial .Juns..5., 19.43..
(If body is to be temporarily held,fill in space later) ,..-...,.
The Certificate of Death containing the above stated particulars, having been presented to me, after- .refal%ami,-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUI E1 BY CAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered-
Number, and on the basis thereof I HEREBY GRANT A PERMIT =
to .Re&era..k...0arissxalo_n..Inc. Hudson.••7al�le 'li..;...y;,
tinter b ar (Address) rc_
the to hold temporarily and inter the body.
(Undertaker or person having charg�ey of corpse) (Inter,semovuoor othe se disoose state-howl)
Dated June..3., 19..43. (Signed) 7Airtnrocri..tl b..
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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