Horawick, Oscar Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tdr 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 CERTNCy�T OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. �77
Dist. No r�.4.l....County. X?. VLi11 ge....S rattle"
�I C' y (IP city, give street addre )
Name of deceased ... . ‘44 ..
QQ�".,p� Single, married, widowed, �/�
Sex. . ... Color T4{�ff' or divorced (writhe word) Date of th.. .. .. /al.9.T..
Age 4 9 Years J..l... .L.... . nths CCJJ , Da s i thplace ..,.. ... �.
Cause of Death .. . �XLCI,ra► s�! .. . . • ./.Q.... .
Certificate was signed by .d.. eQ .
Address.. 7-4-1-0/oe-
1 h
Place of Burial (or Removal) .../..,tt.<r.--x.... . . . .
(IP body Is to be porarily held rlft ep a er)
Cemetery �V,,/./ Date of Burial.... ...../ 19., ...9
(IP body is to be temporarily held, fill i pace later)
The Certificate of Death containing the above stated p rticulars, having been presented to me, after careful exami-
nation, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Loca ecord with the
above stated Registered
Num , and on basi thereof I'�IEREBY GRANT A PERMIT'�'u�C-'v f��l.��'
to o .a �
am Address)
the to hold temporarily d the .'•dy.
(tin rtaker • ) I,t r- - -..
Dated. ... ... 1....l.. ...19 (Signed) �/���"�.. i- �Iy'I�=' �
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subje to local
cemetery or other regulations). unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is req •red.
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