Johnson, Mary A.-
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
re- 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 CERTWII'4TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No....`0 (P
f ,, image
Dist. No... .L.b..ICounty �1.. or City .eQ
Name of deceased ` (Ii city, give stree addre
Veteran
• le,irr(ed, wed, ) �,J,.L.l1`^� ate of (t veteran, give name of War)Sexg
olor.... div, ced w e word IINN geeed.1;....e9Age 7 Y� rs 7 Months........ t.........Days Birthplace.
Cause of Death..
Certificate was signed y ... ~ ,. .. . j.1.,,--,,, M.D.
Address -..i �,',•
Place of Burial i emoval j.. .. ....
(If body to to be orarily het n bpac later //
Cemetery .�! ., � �� Date o urial >I-4-1)- 1.3 19..1e4.
(If body to to tie temporarily held,fill in space later)
The Certificate of Death containing the above stated pa t' ulars, having been presented to me, after careful exami-
nation, the same appear, g to be COMPLETE, CORR -.CI', AND SATISFACTORY AS REQUIRED BY LAW,
I have cepted the same for rt isiwation, have recorded it in my Lo I Record with he above stated Registered
Numbs and on the sis ereraf '-'` .:Y GRANT A PERMIT `
the ...( ) to hold tempi>rariI d d es)r the body.
( taker or a via r_har a cor se) In D �p g g p , r e,or Ise dienoee [state how])
Dated 19/14(e- (Signed)...... . .. ... .... t.�►.r,Ir,.,,/
SLoca Registrar
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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