Brown, George Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tir 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 CERTIFICA OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Re istered N . �s,S /
/ / Village-)
2
Dist. No 6 d (County. .e.�r.--.-. - or City ..A..8, •, 1 - '�
(If city, give street address)
Name of deceased.... AVeteran .------
Singl , arried, widowed, --(�lf veteran, give name of War)
Sex �yr .Color or divorced (writ word).... Date of eath�'t-4rr ( ?)... ....19 54
Age 41R..V Years i Mon .. .....Days Birthplace ..., �y o�,
Cause of Death eal.... . . .. . -...... ..:
Certificate was signed$., �. ..i... .. .. ....2 'L•�.. M.D.
Address
Place of BurialRemoval)........... / ry`'
rarily held,811 ins ace later)
(If body is to be � �� ,/
Cemetery Date of Burial 19..)
(If body is to be ()rarity held, fill In apace later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same apse%ri4.g to be COMPLETE, C0RI CT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accept the s e :,- ,.se' r- • . ,or, . it in my Local rd ith the a state egistered
Number, on the h I;airyR, A PERMIT —2i'
or— di
Aithe (Address)
the % , . . % /. :........ . hold temporaril and .... ..... the y.
tier or persn roving charge of se) nt , v r otherwi nos f state bow])
Dated �/ 19.. x lO (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject o ocal
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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