Doney, Louise Form VS.6L NEW YORK STATE DEPARTMENT OF HEALPTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 CERT IG� .T OF
DEATH, LEGIBLY WRITTEN IN
DURABLE BLACK INK. Town / Register d No
Dist. I`To� / y. Village ..Y� L•.��� ,, 1. iL� .
��Q.! Count or ll
o (If city,give street address)
Name of deceased air(- 41,L1 !�?�-. . Veteran
`!�� Ingle, married, widowed,. G (If et ran, give me of War)
5e a.I C o I o r r divorced (write the word Date o 9'/. ..!5
Age 7 3 Year . -3 Mo s a�.�.D Q irth lac
Cause of Death. . . . . .. ..
• , • -7 tr%
... . . .
•
Certificate was sign M.D.
Address.. ... • • .
Place of Burial ; r Removal
(If body is to be te,•./.rily I s later) / /
Cemetery.. :.1 /.c.. .. .. . 1'' -aJ Date of Bu //j 19'..ii%.?
(If body is to be temporari y held in space later)
Thq Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearit g. to be COMPLETE. CORRECT, .AND SATISFACTORY AS REQUIRED BY LAW,
I have accep • the same for registr tion, have ecorded it in my Loca ec rd with t ;Above,stated Registered
Number . s7 .n the`',': t• •f ; f Y RANT A PERMIT
/ 'a c, .. (Address) ;,.> ")
.the ... - . i.-' ............to hold, temporarily and. .. . 0 he body.
(U ker or pe f, havingg����+arge, yoryse} (Inter ore, •r odery Ia'o elate bo )
Dated.A ' '... l`S`..19. �...(? (Signed) ,t,A.---,(-----)
- Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a •. y to any part of t 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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