Reed, Harold }brill VS.61. NEW YORK STATE DEPARTMENT OF HEALTH •
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ter 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 IN DURABLE BLACK INK. Registered No
Dist. N SPi7County ,.,. „ Town
ltCftabe �R .
oc-Gitv /�1 /J(if cite, rice s',r.•�-t a:i ress)
Name of deceased :rLrC,��
may, Single, married, widowed,
SexC.IC..... .....Color400j or divorced (write he word).... ..... ... Date o- c ath.. . .. . . .. . . 19. id
Age IS? Years if ', ontlii XV Day.- - Birthplace
& tn�e of Death __._�.-
ex_ , te._assx-signed a
d by „ _
. . " . 1.D.
Address
Place of Buriil I of kemoyal i (12
(if body is to be temi�� r�ra�y h ace later)
Cemetery �it�/. ..1)ate o Burial. .. . 3 19. .c'f
(lr b.,.i) is to be temporarily held. till in space later)
The Certificate of Death containing the above_ stated particul s, having been presented me, after careful exami-
nation, the same appearing to be COMPLETE, CORREC, AND SATISFACTORY AS I:EQUIP ED BY LAW.
I have accepted the same for registration, have reco ed it in my Local Rec with the above ta: d gistered
NumbVd�ion sis er E Y GR T A PERMIT ......f/ 7&' '
Address)
e�t.c .. to hold tenlpor� van yyythe 'Ely.
[:.keg or pers sing charge c�,rl se ant love,or otherwi. ddsnose of [state how])
. 1e
1 r,: ;, 1. � \ r
i nf'i� .. ......... ... .fit.. ... .. .. ..
Local Registrar
This Perm' is sufficient for the Removal (and Interment o ems ion of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carri r, in wh' case a Transit Permit (VS No. 62) is required.
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