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Hopkins, Mary Form is 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 IN DURABLE BLACK INK. Regis ered No. ,,{{ Town Dist. No. �.l Count. -Village �[ - (If city, give street addres Name of deceased 7,1 ... 1 //''// Sin e;married, widowed, Sex..9.,„ Color..L i, ....or 'vorced (write/he word) ., .... Date of eac�h 19 .... Age X ? Years............ the Da Birthplace � .4� ��C�.' g P Cause of Death _�% .. 4 Certificate was signed by M.D. Address /7 r .... Place of Burial (or Removal) -� 71 c (If body ie to a porar y held i space later) Cemeter ...... Date of Burial /40 19. (If body is to be temporarily bald. fill in space later) The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami- nation, the same appea-'ng to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW. I have cepted the sa e for r on, have recorded it in my Local Record with the above stated Registered Numb , and on the s' er . . 1H� Y GRANT A PERMIT c_,,,ss /(9..,.....- to... ' / v'.: teas) thr ... . .' . ... to hold temporal' anda2,v the body. (LT • or ,e ,.baying charge c y$e) I c.e ove,o, otherwise die se of[state how]) Dated `` 19..� (Signed) Loca Registr This Permit is sufficient for the Removal (and Interment or n) o body to any part of the State (subject to local cemetery or other reenletions). unless removal is by common carrier. in hich c e a Transit Permit (VS No. 62) is required. r.►•.o 9 rbe O w w ,n a'.toc n.. o E b 0 0 *' n r+O •+ 0•b + v w -, < n S.0 0 » w y ^^ G A Q'O 0 A ^ .., ,O rn.+. 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