Durrin, Ardin Form VS.u. 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 CERTIFY TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.._.•i.j _.
Town
Dist. No 575C County Aashin&ton Village Argyle
Name of deceased
Ardin L. burr in or City (If city,give street address)
Single, married, widowed,
Sex...., a l e Color •4 t-1 t o or divorced (write the word) 'w r r 1 e a Date of Death December 2 719, 43
Age 83 Years 1 Months 0 l? ys Birthplace To.sttz..a ....Ie,G sUzc,l...L...
Cause of Death e n 1 1 t y
. Bar r°Kffia7Y ^--
Cerfificate was signe3 by — Ray..:_ M.D.
Address 'C. t... ,:t:,! rty.,t..Y..
Place of Burial (or Removal) 1 ine ilex Cemetery uler .Falla
(If body is to be temporarily held,fill in space later)
Cemetery Date of Burial sec• 29 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 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
Number, and on theb>�sethereof 1HEREBY GRANT A PERMIT
to South Glens 'a11s,l t; .
(Name). Address)
the V1 erta er to hold temporarily and e� he body.
(Undertaker or person having charge of corpse) ( , move,o othe of(state 1)
Dated 1'?ect 28 19...: 1. (Signed)
.... .. . .. .......
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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