Landon, Mary Xerox-r`_nI. NEW YORK STATE D ` T OF HEALTH
OFFICIAL BURIAL ( i. NAL) PERMIT
le This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District ( own,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF i-s _ OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No....... .
c-trywrr
Dist. Na .I `/(-/..County � �v -
0 1ty (If city, give street address)
Name of eceased
/// Single, mar i , widowed, ! ‘
Sea... ...t.. .. ..Color«/ or divorced write the word). Date of eath / 1 I"
Age (p Ye �� /,C��. ....Months `L Days Birthpla - 4
Cause o Death a4-°`�'`' '
Certificate was signed by.. . . ... �.,. • .a"--a M.D.
Address // . `Y,t
Place of Burial (or :'mov :?(--,., ,.,(If body is to be temp' rily held, 61 1 spec at /! f/Cemetery t-l'e-i'"Irfeelateurial "7 l9�`
(If body is to be to orarily held, Ii I in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the sa appearing be PL E, CORRECT. AND SATISFACTORY AS REC) TIP :D BY LAW,
I have accept he same f r st o ave recorded it in my Lo e d with the ov ted Registered
Number, and the basis to Y GRANT A PERMIT �/yto
m d ess)
the .. to hold temporarily .... . . the body.
(Una keg or person h n char or se , rem ve,or of ise/ s oae of[s a how])
Dated /� ,1 g 19g . p ) (Signed)....
Local Registrar
This P it is sufficient for the emoval (and Interment or Cremation) of a body to any part of the Sta 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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