Stimpson, Walter le rn% A N.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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 CERTIFIc rLE 91
DEATH, LEGIBLY WRITTEN IN DURABLE B CK INK. Registered No 4...
e
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Dist. Nn.�.h..dlCounty .. � ^10".
3 �y 0 (If city. give street address)
Name of deceased i9Z/i) yr::Zr.G-
}/' �, / Ingle, married, widowed, ..
5e. ...y... . ,Col divorced (write die word ate of Death .. j��'.a'.c� 19M
Age •• Years Months 4 s Birth lace. L�-40k .�p
Cause of Death 7c. .. .. '
t Certificate was signed by • M.D
Address
Place of Burial . 'emoval . AP---/d",
(lf body is to be te..p. lily he d, fill )ace later) Date of Burial I9.... ..
Cemetery ..," '4� 4.4—/ / ,
(If body is to be temporarily held. till in space Iater)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accept the same for re ' t ation ve recorded it in my Local Record with the above stated Registered
Number, a n the basis they Y RANT A PERMIT
to 4C�t✓�(.0
/ le7..
cN ( )
the ) to hold temporar'l a the body.
pq�9 a
(Untie r or person hax:ig ..charge o r e m r ep te howl)
Dated ... � -S 19.... (Signed)... ..
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the S te (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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