Comeau, Clement Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tT 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 •� ,�nRegistered No. 4')6
Village `='fie/ ,
Dist. Id'��d, County///���Yc��,.,.c _ J orCity e (If city, give street addree
Name of deceased Veteran
Sex 7�� �� Single, married, widowed, (If ve an, give me of War)
�-'� ,olor G�f or divorced (write the word ...Date f Death .. l4 19 4L
Age......677 Years // Months m2,a......Days Birthpl
_, 52 7
Cause of Death .... .. .. . .. .. ....
Certificate was signed by .... .....:... ...,. M.D.
Address 51
Place of Burial or Removal} �y „_
(If body is to be to o rt h d, fill to space later) /J
Cemetery ez--[� G/ Date of: uria;. /..� 1A
(If body to to bet mporarily hel fill in apace later)
Thft Certifica a of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE. CORRECT, MCI) SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration have recorded it in my Lo I Record with the above stated Registered
Number, an the th reef I •BY R NT A PERMIT
to L_-.' • .4.
/ .( as
the ..to hold telnpor ' arid.. .the body.
(Under er o //wing charge y9t�corpse) re o oth Ise of to 0
Dated �.. 19."Ys► (Signed).
Local Registrar
This Perini is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (su act 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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