Gifford, Bertha t oral .s.al. NEW YORK STATE DEPARTMENT OF HEALTH
eT
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration istrict (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN I RABLE BLACK INK. . Registered/.. �i� No
5 3
•7`��0. Town- 7 st.
Dist. No, . ..County ge �Q ..... ..... .. .
ity • I city. give street ad$rest)
Name of deceased ,, .. _.
-Single, married, widowed, e,
Sex .r�lM3...0 010r G�G�1i�r divorced (write the word) ..Date of Dg1th....•.�.,_. • �C 1943
Age ..1" \ onths a2 Days Bir hplace % 1Gt �G. .. .
Cause of Death. .. / J
Certificate was signed by *.. M.D.
Address i cr,,,l.4v., • /If
Place of Burr (or Removal) /�GG444Ki. .. O '., `,.
(If body is to to porflrtiy hel 11 insrpace later - // 'rr''
Cemetery.. .. e (�.�(�•� Date of Burial 7.e. -..� 19.>
(if body iN to a temporarily held. till in space later)
The Certificate of Death containing the above stat particulars. having been presented to me, after careful exami-
na ion. le same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I . :ve a cepted the same for regi tion, have recorded it in my Local Record with the above stated Registered
Nu •er, and o the bass I EREBY GRANT A PERMIT
to.... '�' � ram"
( me) (:•• ess) ,
the .to hold temporarily nd.. �a .. / the body.
.,
(L r�oy person havingchar e�.oj&,.c�or se er, remove or erwi :• • I • i o+ 1)
Dated T ` .. 19.'7.`' (Signed).
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ubject 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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