Ogden, Gertie 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 CERTIFICA OF
DEATH, LEGIBLY WRITTEN IN DUR LE BLACK INK. Re istered No 43
/ Town
Dist. No:5IP(51/ County af./ Villa.
�i ' j ��' (It city,give street addre
Name of deceased
Singler-ezarried, widowed, •
Se -� ColorG�%F�Le� or diyorl (write the word). Date Date of De // 197` ,
Age G 2--Year 7 Months ,.Day ' h --).'-'r'
Cause of Death . ... .
Certificate was signed M.D.
Address
Place of Burial (or Re al) 17--
(If body is to be tempora d, s er)
Cemetery Date of Burial /T —'"'1ia
(If body is to be tem orarily held,till in space later)
The Certificate of Death containing the above stated particulars, having been presen ed to me, after careful exami-
nation, the same appearin: to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accept- . the sa e .r e_";,'a:"o f ;-ve ecorded it in my Local Record�co with the above tated Registered
Number, ;�i j n th. f 4 r1.•. B 'ANT A PERMIT�-��%�r c �7. / •
the !������.. . to hold temporarily an ( ..the body.
(Un :.er or p f.on h g charge/of corpse) ve r otherwi to l)
Dated ... i,.. .. 19.if�'�.. (Signed) Gs
Local Re strar
This 'ermit 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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