Barber, Baby boy Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
is 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. Town Registered No....ca-6.
�,,/ Village
Dist. No.� (1J County �Y or City
(I2 city, give street address)
Name of deceased '`.- Veteran
' gle, married, 'doomed, (lf v eras, give name of War)
S olor divorced (wri a the wor Date of eath.. ' . J 19174
Age Years.. Mon s / ays Birthplace... �..7?. .
Cause of Death........ ..... .. . .
Certificate was si ed by .,, M.D.
Address
Place of Burial (or Remo aI)...
(If body is to be.terhporarily fill in space la r) ) -
Cemetery..,,:.. .. ��((((((////// �--4-c 1 Date Burial . .. ...... 2 19 A4
(If body is to be temporarily held, fill in apace later) •
The Certificate of Death containing the above state 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,,aagl on the basis thyrAwf I ER Y GRANT A PERMITef
to wem4
a�rtt dress)
the eer—,,...r•�-i............ .... . to hold temporari' n .. the body.
(Unertaker r pereo aw qqsr ing charge, corpse) r emove,o be dispose o t bow])
Dated ?.'-'''e / 19.. 4 (Signed) ,Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 6 ) is required.
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