Cole, John Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH -----------.
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fa- This Permit can be signed only by the Local Registrar (Deputy or sosbregistrar) 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 ..X..3..
Dist. Noii67.61/7/Count . .24,e2fit/ Village /
or Ci /ere& give street address)
Name of deceased
.i
Sex... ....,.. Coloyee4e. .. . . .o-indivo' * Date of Dea
2./..., la Y'
Age .0
Sex..
Years rmceadrlesArd_I:itweidtoiewuerdo,rd). ..
Months... ... .. ........D s . B. thplace.V... ... . . ... i..e4.. ..
Cause of Death•
.. •
•
•;/.2
-.. •• •• •••
M.D.
Certificate was signed by... .. ... ... . ...
Address
Place of Burial (or Removal) _,...,76C(..-
(If body is to b porarily heldei2n,space later)
Cemetery . . .
....9
Date of Burial 4 19 y !
(If body is to e temporarily held,fill in apace later
The Certificate of Death containing the above stated par ulars, having been presented o me, after careful exami-
nation, the same appearing to be COMPLETE, CORR T, 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
Numbe and on the ali2 tizof I REBY GRANT A PERMIT i
.. .. . .. ...... .5.?.4A to. -.C.-•7 • • • •
ress)
the to hold temporarily d ..the body.
(lInclerta or person ligrg charge 9f corpse) ,remove,or otewise e [a ow])
Dated 19.4.3 (Signed)
Local Registrar I/
This Permit is cient 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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