Stebbins, Elizabeth Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Pr 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN
WRITTEN IN DURABLE BLACK INK. Registered No. of GX..
Dist. No.-SZ°/ County ,�2 — y ae _ �µ.i
O itv (If city, give street addres.)
Name of
eased `
,,/> Si5,465e,
rried widowed ��) '
SexD Color...( •.or divorced (writhe wo )(X/ Date of eath . a/...19,t
Age r Years „. Months s irthpl.lc / ^''
Cause of Death '. . . ...akmi.a, .... Eye
Certificate was signed y aid M.D.
Address
Place of Burial (or oval .. )'
(If body is to be temp/�/ .�"eld I p I r
Cemetery — Date of Burial. ... 3 19)
(If body is to be-temporarily held, li!! ' space later)
The Certificate of Death con aining the above stated particulars, having been present d to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT. AND SATISFACTORY AS REQC;IRED BY LAW,
I have acce.,�' the same for re:.:t` ion, 11.0.,: - r .rded it in my Local Rec d with the ove tated Registered
Number, an ,on the bas, • .f NT A PERMIT '..�T/
to • r%i O• // i. %%% v /
(Naar' ( ss
the ! to hold temporarily a tit ody.
(Uncle ':ker or ••rson h vl;P arg o fse) In o rot .rw' Is-a) [state how])
Dated... ..1 i .-I (Signed)
Local Registrar
This Permit is sufficient for the emoval (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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