Hart, Delia Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Cs' This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (T wn,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFI OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No...3.. ....
e
Dist. No,D .....Count . • r City
Villa 2,01,E ,, ike
o 0 g (IL city,give street address)
Name o deceased Veteran
i.
Ingle, married, widowed, o veteran. env ,name w.=)
Sex .seal lor,..... . .or divorced (write the word). Date of 1 e.....Age 7 5 Years Msnths ./ .. ays Bi acdX ,..
Cause of Death ,,, •,,,Q Q ,Certificate was ..
Address, ,. ,. ..,
Place of Burial '.r Remov l . /17
(If body 1s to be t,;y 11y h 1 s e later)
Cemetery - //hh
. .. ... .. :...Date of Bu i .. . . : . ., . :...,l.�r- 19�
(If body 1s to be temporarily held, in space later) - a
The Certificate of Death rontaining the above stated particulars, having been presented 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 r orded it in my Local Record with the above stated Registered
Number, on the basis thereof I. BY ANT A PERMIT •
*/
N O d =ss)
the "�l to hold temporarily and �, the body.
dertaker or a havia;charg .sy ae/ `"'�� rp ) (Inter,re ;,1�or�,he .� dT-`boe�� r °te how])
Dated 19.,, ,,. (Signed) � /� ..:..- , . . .
°call R strar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the to (subject to local
cemetery or other regulations j, unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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