Mitchell, Edith Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
2 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 CERTIFyF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
Dist. Nth / County :4
11, e. (If city, give street address)
Name of eased
Single, married, widowed,
Sex. olor Gv ...or divorced (wr't e word .Date f Death 1 ".,.�
Age 4.r• Y o hs .: ays • / --s--l-G....
Cause of Death
Certificate was signed b 124 ............ M.D.
Address -
Place of Burial (o " e oval'. .. .. ..
(If body is to be tempo r hel la
lace later)Cemetery Date of Burial... .... ;71934
(If bodyis to be m rar y held, fill r)
The Certificate of Death co ining the above stated particulars, having been p sented to me, after careful ex-.mi-
nation, the ,e appearing to e COI • imp' !OR ' -C[', AND SAT r TORY AS R1�C.2 D ;Y I AV‘-,
I have acc- . sd the same for •. r do• ?e - .: it in my L d with the e s Registered
Numbe , • •n , . •sis F - 8 :Y.ci ' T A PER
;j �� .
.�to
`fit /
the �► to hold temporal y a the y,
nd• t'k• or rersou in_ charg ,o pee) move,or otherwi . [state bow])
Dated.... -4' ... ... .. 19.. .. s (Signed?.
Local Registrar
Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subje to local
ceme ry or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is re ired.
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