Hunter, Delia Form'Vs.61. NEW YORK STATE DEPARTMENT 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 CERTIWATE OF
DEATH, LEGIBLY WRITTEN IN DI4ABLE BLACK INK. Registered No....V :A/
Dist. Ntat O/ County or City
. (If city, give street address)
Name of d.eased ,•• Veteran
eti Owagle, arm 1 ied, widowed, i/../' (Iferan, give name of War)/ ....i,
Sex... ..../.... °tor ... -40.eV-aor divnrced (write e word) Date of ath. ..19 Kt-
Age .X. Years ' Mon 2- ........Da s Birthplac ... ../.71.A....--
.-:.:.
Cause of Death •
‘•
Certificate was signed by... . • M.D.
Address , 1
Place of Buria [o Remo 1) t
(If body is to b porarily el , till in s ce a
X/
Cemetery.. ' Date of Burial •//0' 19.....
(If body is to be temporarily held, nil in space later)
The Certificate of Death c.mtaining the above stated particulars, having been presented to me, after careful exami-
nation, the same appearii. , to be C9fl L , - RRECT, AND-SA'FISFACTORY AS REQUIRED BY LAW,
I have acce.t-. the s ,0.1,,-,or gis ' ri e orded it in my Loc Re d with the a ta d Registered
.n Number . .."' th- .4 r4 w- 'r• r
• 104, Y ANT A PERMI .
a ) ddress)
the - ..to hold temporarily a d the b .
(Un. e or persogving l char e corpse) c ve or otherwise d 6,,o te howl)
Dated s &e....„.. Signed) — •••
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to ea
cemetery or other regulations), unless rernovol is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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