O'Connor, Delia Form VS.6L 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town �f� Registered
No. S�
Village
Dist. ATo�'7�/ County Cityor City
/ (If city, give st set address) .
Name of deceasedZ �� . Veteran
Single, ma rif ed, widowed, (If vet give name of War)
S . olor.. or divorced (write the word Date of Death... �........ �b 19,
Age 7 Years Mo the ~7...... ..Days Birthplace... . _,.. , . ....c) h
Cause of Death
Certificate was signs by ,.., M.D.
Address e - ), . 'V
Place of Buria (or Removal) i
�. (1
(If body ie to be or$rfi�y lyPld, II n space later) ��Cemetery „((�i�� �(�' � , JA—,1 -t, Date of. urial. ./..7 19:7� a
(If body is to be temporarily Id, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented Wme, after careful exami-
nation, the same appearing to be COMPLETE. CORRECT, AND SATISI=ACi'ORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, the basis t�heec�eof Ij,HEREBY GRANT A PERMIT
to tom"" • ,1-1—..... 50.r�-�r1G�
(PI me)' v (Addt
the �,1 . ....to hold temporarily an��yl the body.
(Unde r or person having charge of corpse) �/ /(Int ove,or otberwi ose of how])
Dated l? 19...54 (Signed).. c ... .
Local R
This Permit ' 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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