Patterson, William Fonm:VS.61:' NEW YORK STATE DEPARTMENT OF HEALTH .
OFFICIAL BURIAL (OR REMOVAL) PERMIT
/or 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. Registere No.
Townge /
Dist. No:. i':��� ....County.. \Tge
t i r Cl-t (If city, give street a dress)
Nime of deceased . ../
�7.�.� Single, married, widowed,
Sex"J- Color- or divorced (write the word. Date of Death.... . -2 _ 19 t4-
Age...)3...3 Years.... . Months Y Dais Birt place ,
Cause of Death y.
Certificate was signed b �� 7.. M.D.
Address
Place of Buy ial (or Removal), .-44. . 11, E .,.,.,,.`7 4-cerr) .
(If body is to b emporaray hel ,fill in s ace later)
Cemetery.... ,..; . P .1 Date of Burial.. a A 19 417
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been presente to 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 _
Numbe nd on the .td_e64e7r ---,
b thereo I EREBY GRANT A PERMIT,[�
to
(Name) ress)
the e( 411T. to hold temporarily and t, Ille body.
(IT dert r or person having charge. .corpse) t..,� (I y er,r ye,or erwise dis.ose of[state howl)
Dated. /.. .� !T 19... S (Signed).........Of N.::... •
.. . ..
Thiir'Permit is sufficient for the Removal r Local Registrar
(and Interment or Cremation) of a body to any part of the State (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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