Cartier, Napoleon •
61. NEW YORK STATE DERA.TMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIF &A;IjE OF
DEATH, LEGIBLY WRITTEN IN DU BLE BLACK INK. gistere No. l��/.
'// J Town o
Dist. No YJD(.••.Count Villag . ...
or. g (if city, give street address)
G
Name of deceased
,�/ Ingle, married, :owed, G ySeColc>��l/ r divorced (write the word) 1 Date ' > .tl A e Years . .. .... nths....� Da s a Birth la .. L/�g j�...� � Y P Cause of Death
Certificate was s'
Addres .. . . .. .... ... ..
Place of Burial •r Removal) /tom .: ,
(I£body is to •�� eerily held, in slaw; (! l '
Cemetery _% . .. ... Date of Burial.. . . ...3,/ 19.ib
(If body is to be temporarily held,till in space later)
The Certificate of Death containing the abo e tated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLL E, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acce ed the same for regi ration, have recorded it in my Local ec d with the a e s ated Registered
Number, doh Ober El R T A PERMIT
to .....
a G A d ss) ,ram
the to hold temporarily and .... ..... body.
r er or perso •ving,4111 e rpse) er, rei ve,or otherwise .ose-of tate howl)
Date( .. . ..tjt 10.7 (Sigmed) .,n..a-
,,,,,, .
Local Re strar
This Permit is sufficient for the Removal (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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