Cunningham, Felicia Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
re 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 INN`DURABLE BLACK INK. Town Registered No.
Dist. No. 4.S..7...County..../d 'i^./e Areity
(If city, give str address)
Name of deceased ... . . p '7tJ Veteran e—
N �� ��� Single, married, widowed, Q (1f v eras, give name of War)
Sex. .... . . . .Color.. ....... ..or divorced (write the word) . Date off?path 19. L.Q
Age r Years.....5� Moths...4...,. Da Birthplace...fl.V.. . A'....C..a
Cause of Death
Certificate was signed by - .i M.D.
Address ,,,I, 1, „ , . ..� v
ij
Place of Burial (or Removal) Jt 4en.
(if body is to be temporarily held,Alldn space la _
Cemetery ,,...t./;��.1 I . Date of Burial C �d V(07
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above s ted particulars, having been presents o me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on th b$sia thef I HEREBY GRANT A PERMIT/,�& _.0-1. `J�/
the i .(-',f'I`C'�J {N m.) to hold temporarily and c= . (Address) the body.
(Und k r or rep aving charge of orpse) J (Inter,remove,*o er�yise dispose of[state how])
Dated . 19... 4 (Signed) jf ti ,, ;;,L..,E,-!lam t
a ;L , Local Registrar
This Permit sufficient for the Removal (and Interment or Cremation)11 of a body to any part of the State (subject to local
cemetery or other egulations), unless removal is by common carrier. in which fAaB a Tranai! permit (VS Nn_ 62) is rceuired_
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