Silverman, Lena Form vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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 •RRECT AND COMPLE CERTIFICATE OF
DEATH, LEGI$t,Y WRITTEN IN IX) BLACK INK. /
N // Regis,. - . o. `
Dist. Town
Coun 4 r ..X
�, r��* ity,give st eet ad
N 'deceased.
met', arried, widowed, / _
o .... .or ' .orced (write the:;•yr�/ ._,,Date of De ..r!.....
A e ears Month, - 4__ Birthplace. - .ram... ...
Cause of ea ' , . -- 1 4 �� .. ;,i ;; '�
was si t <--Certificated b"y... - -�. _ - 0- ... ..
i
Address
Place of Bur Removal)..;.,`!�' �,/�
/'
(Ii body is t De pore y -Id,Sll kl r) _
'-Date of Burial
iv
Cemeter :. - I 19
(If body Is to be temporarily be .s iu":•:Ce later)
The Certificate of Death containing the above stated particulars, having been ; esented te`me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISF CTORY AS REQUIRED BY LAW,
I have a pted the same for r gistration >�iave recorded it in my Local }th the above stated Registered
Numb , d on�-.the basis.threof I H RE GRANT A PERMIT
to .. .1,�.e.: 15,1.`,.- :-s /6�
blame)' } ress)
t to hold tempora the body.
(U t of person havingchar orp
�,,+� (Inter,remove, othere�{Iisooseyl-[ i)
Dated. ;, 19 -` (Signed) ..,,�— oA"e*-,
Local egietrar ,
This Permit is sufficient for the Removal (and Interme. er 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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