Eplen, Joseph torn %F.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Towi
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFJ &TE 0
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Ge tered o. ��ff
ttQ � �/1R�-• Town
Dist. No�.].G?.....f.County Village.. .. ... .. .. ......:.. .
or ity (If city, give street addres.
Name of deceased
/ ' ) S' e, marl' d, widow , �y
Sex Color w divorced write the ordl Date of De< h a 1�
Age 672 Yeas y- Zonths y /. Birth ace.... ... ... ..
Cause of Death.....r..... . . .. ..... . .. `.... ,q ,�/
Certificate was signed b L
Address aq
Place of Burial (or e, ovate �4-�etru... . .. . .. �J
(If body is to be tern o . it,, el�(T s ter) / -�s�,— �e
Cemetery ;ti4 ��. ��/ Date of B rial -�` 7- /� 19,,/..�
(If body Is to be tem y he ., Il space later) J
The Certificate of I eath co ,aining the above stated particulars, having been presented to me, after careful exami
nation, the same appearing to be COMP-ET CORRECT, AND SATISFACTORY AS REQUIRED BY LAWN'
I have ace t d the sa e r *�
p �gIs �. , f� rec: ded it in my Lo R rd with the abo sta Registerei
Number, o' e ' t-;- eo�• :•:: G:/rNT A PERMIT
,.: (A sa)
the I . ' ... '' to hold temporarily an th ody
(L'nd r perso vying charge c r) I t e,or otherwise to ow
Dated /0 19 ... ( ) .... .. . . .. . .. .... .......... ... . .. ....
Local Re ar
This Permit is sufficient for the emoval (and Interment or Cremation) of a body to any part of the State (subj ct to loca
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