Miner, Baby girl \
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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 CERTILyi OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No. -47
Village
Ao,v,4) CP/c-teid 44.7.: 1
Dist. No.64,00./.County (.(6iefeta--21•C..- or City
(If city,give street address)
"EaName of deceased Veteran
Singl married, widowed, /
(If veteran, give name of War)
See'114.4)4C0i0r.CV or divorced (write the word) • , • Date of eath. ..19 0-6
Age Years.. Months
Cause of of Death
M.D.
Certificate was signed
Address
Place of Burial (o Removail)
(IP body is to be t mp rily he l
ld, 111 pace later) . d
Cemetery Dat f Burial 10 19 4l6,
(If body is to be t rnporarily hel ,fill in apace later)
The Certificate of Death containing the above stated particulars, having been presentede to , 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 the above stated Registered
Number, anrn the basi tIrrofe,b1-1Eg3L GRANT A PERMIT "....ta..6...e.......) ‘., :f.......e...40.)
to .
the €44--044.7 (Aildre) to hold temporarily and. the y.
(Undertaker or person having charge 4,corpse) t e ot e ose ta e ho ])
Date& 7. (Signed)
Local Registrar
This Permit is fficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject t local
cemetery or other r gulations).unless removal is by common carrier_ in ‘ntii.-h ..... n Ti•nini4 1,..inis (VS Win R91 :. .....26
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