Carpenter, Estella Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT ,
gar 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. 41:19
mum
Dist. No...5.60....Count r ren S
y e...�r. .�t�.gQ, t.....C.1..eX1,S...Z+.'a.a..1S.,...N.....Y....
or City (If city,give street address)
Name of deceased ES.tP1 lA..I1.....Carpenter
�;� Single, married, widowed, ,
Sex. .F..elilafCiolor �7.�,:� ..or divorced (write the word)... 4;✓�,x'a.�Ga Date of Death..De.C.....27t, 19 4
Age 50 Years 7 Months 24 Days Birthplace ito.€` - s...NP.W...XQ.r .
Cause of,Death Suicide- Hanging
Certificate was signed by....F1Qyd,..P 1me.x OQr.azie.r M.D.
Address G1ena...Et.115.,...New..Y.Qrk.
Place of Buiial (or Removal) ....Town.. of 4ue.enahury
(If body is to be temporarily held,fill in space later) i
Cemetery ine..View cemetery Date of Burial...Deem-..Z.Gth 19.4a.
(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 the basis thereof I HEREBY GRANT A PERMIT
to cewP,,d Is...T'Q.tr:rce. ...8.4...J.iarren..at... Ga,ens...F.rala.,s.....Ny
(Name) (Address)
the Und.e,r.ta1er to hold temporari y .fitterthe the body.
(Taadertaker or person having charge of corpse) ( Ukase of s o )
Dated - .C.. 2.9th 19..4'&.. (Signed) i(YV///�
Local Regi trar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ject to local
cemetery or other regulations), unless removal is by common carrier,in which case a Transit Permit (VS No. 62) ' required.
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