Rawson, Baby girl > sn Vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
vr 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 CERT)'ItyyX OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No......�t `f5�������jjjjjj
Dist. No County 'farren vc,ffei Glens I,'alls1R.F.D.;; 2
or City • (If city, give street address)
Name of deceased BdbY Gii°l Raw on
gle
ied,
Sex f ernaleColor Whit wed,
6 o rdivorcedr(wri e withe word) Date of Death g• �.,L tb. 1.9.4. .
si le �:u , .
Age Years Months 1 Days Birthplace Gle n S Fa ..1..,...;.IQ;?p.1.tal....
Cause of Death prematurity=Birth at 7 month - Twj.rl...P.r.e.gul xl.cy
Certificate was signed b Dr. B.C .l'i ll o t s on. M.D.
AddressGle r1s a 114 , i1,X..„
Place of Burial (or Removal) West G, ,e 14•9 au.S,,, lve Yo ........ ..
(If body is tq,be t mp rily beld 11 spaceriater)
Cemetery es eels rails sera tery, Date of Burial A U.g......1.1t.x{ 19.45..
(If body Is to be temporarily held, (ill in space later)
The Certificate of Death containing the above stated-particulars, having been presented to mer.a,-£ter 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 � r .. ,... .de ... ,.. 1-��...
f3�aard (Ti O(evgm�e v (Address)
the Ti to hold temporarily nd..�. — body.
(Undertaker o r corpse) U ov or o rw' ls� [state bo
Dated `i.t'i• �-1 4h 19 45 (Signed) ...
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of .L body to any part of the State (subj t 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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YOJIM VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
it2r 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 CERTIF.gyiEser
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
Dist. No Lay/ County 41,.. -4,"-e-"---- N'illa "°1-"<----e*--P- e
(If city, give street address)
Name of de <sed kb-rdek
Sex. Color.
,)eSingle, mar d, widowed,
.C.,(/ or divorced (write the word) ,y 'Date of e h / 19.r.s
Age ' Years , lis. — Days ArF.--, Birthplace ,
Cause of Death. 7..I.
Certificate was signed by.... .. .6..!..C..,. ... MD
Address
Place of Burial (or emoval' .. ....... .... . . ...
(If body is to be t rily d, .: . .face later
dri
Cemetery
. ) - Date of urial 19
(If body is to be temporarily held, 101 in space later)
The Certificate of Death containing the above stated particulars, having been presented t me. after careful exami-
nation, the saple appearing to be COMPLETE, CORRECT. AND SATISFACTORY /k. REQUIRED BY LAW,
I have accep ed the same for re 's atio ve recorded it in my Local eco d with the a v t d Registered
Number, , 'on the b t H Y GRANT A PERMIT
to ..
me) —
(A
the to hold temporarily nd.. le body.
Dated
(Undieloirr or ..•rsorying cha;Ferpse) (Signed) v , r othe we's-) f state )
/
1
Local Registrar
This Permit is infficient for the Removal (and Interment or Cremation) of a body to any part of the State (subj ct 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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