Green, Virgil Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ur 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 C��AT,E OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Regis red No. CZ--
Dist. Village/ J�/
Dist. No�.tPO/....County. % � or City CD GIG G%�� �?/.... ..
O O (If city, give street address)
Name of deceased Veteran
/�2 ' u S. gle, married, widowed, ��`%` 0 (I era iv ..zit-War)
Sex . . ....Col .or divorced (write the word, . . ... . Date of Death. .. ✓� �/�/� 197�fd
Age �O Years ..Months t. ....Da , Q Birthplace .. . 24 e �y. .
Cause of Death
Certificate was si y M.D.
Address.. :.:.,..gi
," .
Place of Burial (or Removal)
(If body is to be temp Geld, fill igpepace lat r� ��/
Cemetery ./. ..z. Date of Buria .. ??. 4.7 19....
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above st ed 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 recorded it in my Local Record with he a. •v stated e ' tered
Number and on th asis a �Y GRANT A PER eiiito a. . tea . . .��'�... .
the to hold temporarily -- d tad�Jreae) dy.
ker or p � yg charg f rpse) ( o or ryr�it di e o h
Dated.... . .P..Z�I I9 (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 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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