Casey, Richard n ' \
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Cir 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 CERTI ICCTF.,OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. =fvavn Registered No...5$-
a V-itge /
.Dist. No Z.County....4f'C' ., or City -.e•
(If c y4, glee street address)
Name of deceased4/ Veteran
Single, married, widowed, (I( veteran, give name of War)
Sex. Color " or divorced (write the word : .....Date of '� O���" Z �9 ‘
Age �� Years nths Day ti Birthplace! ��• . "�i
Cause of Death
Certificate was signed by M.D..,,
Address
Place of Burial ;orb - .ovals ��1-4.-v`v-- .. .I.
C body is to be temp y held, 811 in'apace late v— f I9�/
Cemetery Date of Burial l/•`I �+�� y
(If body is to be to .pnrarily held, 811 in space later)
The Certificate of Death c- ntaining the above stated particulars, having been presented to me, after careful exami-
nation, the same app,°-.r r.g to be COMPLETE, CORRECT, AND SATISFAC!'ORY AS REQUIRED BY LAW,
I have accepted the same r r e, istration, have recorded it in my Local R cor with the a ye stated Registered
Number on thiesi hereof .1 Y GRANT A PERMIT GaZ
tof/
as)
the
to hold temporarily .the body.
(LT ertaker or person h ing...berg corpse) rem e,or of se a of [eta srp
Dated .. / 19. (Signed)....
Local egistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (su ject 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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