Seelye, Mary I orm t•+161- NEW YORK STATE DEPARTMENT OF HEALTH
..-
OFFICIAL BURIAL (OR REMOVAL) PERMIT
%t4- This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town
Village, or City) in which ath occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFIC�E Of
DEATH, LEGIBLY WRITT 14 a URABLE BLACK INK. 7 Re tered No i� (0
��_ / 1 UOVII �^�
Dist. No!*.P./....County.. Vriflage. s% V.- Teate.1
.lty rIf eft . give street address)
Name of deceased / '
7% Single, married, wido d, -
s
Sea...T.,.-�'j.'1.'!r...C:.olor. car divorced (write the word). Date of�Death 'Z� �' 19 �
Age 7 I" ;tn, ,O Months J Days Bir place.-Zi-.tthri... of .,..Ar.)
Cause of Death .. .. .......... .. .. . .. . .... . .. .... ... ..l - ?It,*
Certificate was signed l.v M.D•
Address ye..,,,I • ,!...,
�� ..,
Place of Burial (or Removal 1,,/.,Gto.41V. .
(L'body Is toy�'tt mporaril, ld,huh in s e lat •
Cemetery. Y..4. v'u-� v� Date of Burial 9—:a // 19.. . s.
(II bony Is to be temporarily held. fill in space later)
The Certificate of Death containing the . ove stated particulars, having been presented to me, after careful exami-
nati '1, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I hay accepted the s ef f gistration, have recorded it in my Lo Record with the above stet d Registered
Num er, and th eof I HE EBY GRANT A PERMIT fa.Z
...t.A1 a s) /
to hold temporarily nd.... the body:
(Undertaker or person having charge of corpse) ,remove,or tt env isnose o e ow])
Dated /s 19. 6- (Signed) L(o�.�/.
al Reg tray
y This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the ject to local
etery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 6 ) is required.
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norm I S.bl. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
vr This Permit can be signed only by the Local Registrar (Deputy or subregistr. of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptan - of . ORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
To ,n. An
Dist. No G S ?County...L.LJ .. ,ili-tge f' ...-.
•or C- / / 007 city, give street address) .
Name of dece:- ed - it" v.. , 0'
.� �t �Angle, married, do ed, V
Sea. 1 Color "— ..or divorced (write e wore v. ...� Date of Death 1O
Age 7 ? Year. ,...Monthq .• Cirthplace
yam.
er. ticate �ti<ls sighed by. ,�0011011/11,(4100 IV' . 1 . ...�i.D.
Address _,..
Pf 1' ta _ of Buri:,l (oi Removal i
(if body Is to be temporarily •.i.1, nit in space it e
Cemetery Date of Burial 19
t,lr body Is to be temporarily .II Ins is e ater)
The Certificate of Iea on . 'i r the above stated particulars, having been presented to the, after careful exami-
nation, the same apse. n, ( be COMPLETE, CORRECT, AND SATISFACTORY AS REOITIRC.D BY LAW.
I have accepted the .: e , -r - -istration, have recorded it in my Local Record wi he above sta"ced Registered
Nu• • •r, and on , t: $ - eof I HE iB,.Y� G ANT A PERMIT •
';7' `?'- i e::;;; --2#
ifr Ai
(Addres
.r .., ,.-- to hold temporaril - and.. .. . .... . .t e body.
•-. +c t::•e or person baring charge of corpse) (lute n o•°thew se Msnoae of [state how
1t,
Loca R gist
'this Permit is sufficient for the Removal (and Interment o n y to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, 1 hich case a Transit Permit (VS No. 62) is required.
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