Mattice, Arthur Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Cir 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 CERTIFICyAT F
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No. l
GAL/ Village
Dist. h Coin or City.
(If city, give st t address)
Narita of deceased .. .. ... Veteran ,..
ingle, married, widowe , , (t vt Bran, give name of War)
S r divorced (write the word �`�m ate f Death... .... .. ... .�4 19.7
Age Year Months. ....�/...»»...Da Birthpla . c..o. . ..,
Cause of Bath. �-
Certificate wa si e ,- C�?: t M.D.
Addre .. •.
-• '/.
Place of BOil r Re. oval). ,
. .... .... ... .:
(IL body is t /orarily held, ' ace la r)
Cemetery. ,�-u^,,.. �. ...) Date of Burial s 19
(If body le to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particul._rs, having been presented to e, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acc pted the same for regist-y,tion, have recorded it in my Local Record with the above stated Registered
Num on the asis thereof GR• NT A PERMIT �<�) ,.. .___;/
to ..,. . ��e � ddrd
the / ._. ' . .. .. t, to hold tempor and the body.
(uririt ker or . non ha barge of corpse) er re ove,or o iisejjapia lita o )
Dated „('a ( i/
.. �19..:� (Signed) "`
iLocal Registrar
This Permit is s i; cient for the Removal (and Interment or r at ' o a y to any past of the State (subject to local
cemetery or other regulations). unless removal is by common Barrier. i., w irl, rn.a a Trani;* P.r..,;r (VS N. R2\ ;. r....;r.d_
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