Andrews, James Fort NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tir 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 COMPLETS' CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. .—
Town
Dist. No....3.3 az..County Onondaga aiiiinge Ono nd a.
(If city, give street address)
Name of deceased Jame s Andrews
Single, married, widowed,
SexMals.f W .
...Color Whit e or divorced (write the word) WidOa Date of Death July....24 19..45
Age 79 Years O Months 1 Days Birthplace Cdaahingto.n...C.o......N.... ..
Cause of Death 1413ro ard1,F a. de Elv.ng.ratlon
Certificate was signed by w.. .N......TX`.11:eK. M.D
Address' Onondaga County Hoot ital
Place of Burial (or Removal) Syracuse.,....N....Y...
(If body is to be temporarily held, fill in space later)
Cemetery....P.1ne...View....Cem G1ens...Falla,...11..Y. Date of Burial July 27 19 45
(If body is to be temporarily held,till 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 Oar. ...J....Bal...1tlt.eg 4612..S.,...*Salina St i Syraeuee�H•••Y�•
Urldertlilt* (Aaaresa) the body.
the to •
hold temporarily and inti.f� '
(Undertaker or person having charge of corpse) ( ter,remo or of a se- ose of[state how])
Dated jT.Uly....25 19....45 (Signed) l '
al—Eegistrar
This Permit is sufficient for the Removal (and Interment or Cremali n) of a dy t any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in w ich case a Transit Permit (VS No. 62) is required.
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