Sarchioto, Baby girl i•-orm . .61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
VT 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. Registered No.. AO 0
Is 'lit*
� T-crar'i
Dist. No. �� Countti. � ��
,. r . ,J.ive street addres
Name of deceased r
Sea;) ;�. Ingle, r d w' d, •
/ -' Color kqr di ate�f D ..�T Z...I-19..A
Age . "='I_ •.,1,...•., 'Months .. * Birthplace at
Cause of Death
Certificate was signed I'• .,. •• i 6ti M.D.
Address . .,� ie.i..."..e a
Place of Burial ( Remo al '. .�v�-
,e
(If body is to he tem • Il• , e later)
Cemetery- s Date of Dial . . . . 'AP 19.K1
(Ir body is to be to po srilc held. l to apace later)
The Certificate of Death ontaining the above stated particulars, having been presented to me, after careful exami-
nation, the sal. • appearing to be CO:\I ' �ETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accep -• the same for t: • e recorded it in my Loj Reco with the ab e s ted Registered
Number, an, on the basis `,�A E ;,4:Y GRANT A PERMIT
�1" dress)
the ,, 400"'.�,,.y
,„.to hold temporaril a the body.
(Un er or person having charge r pee) (I m ve or o wis nose o how])
Dated // 2r - , t9 (Signed) E
Local Re trar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Sta e (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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