Bombard, Elsie Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Jur 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 cc ce of a CORRECT AND COMPLETE CERTIFICATE Of
DEATH, LEGIBLY WRITTEN IN DURABLE CK INK. /p �C� . . Registered No. D
--�
To war
Dist. No. o ' County
��////JJ�� �� �� .. .. image. .... .. . . .. ...
,.AC.(4rG e.r or I (If city,give street address)
-Nam f deceased
Ingle, married, widowe , '
S ... . .. olo divorced (write the wor Date of D " / 19
e .,�....... rs ie. Months . ,- Days i place .
ause of Death... . '
Certificate was sig D
Address97 .
-
Place of Burial ,sr Remova
(If body is to be e.'.ora he ,it in s ce later)
Cemetery --'.... .....:.. .. . .... .. . Date of Burial....... - 7 19
(If body is to be temporarily hel fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, . me appearing to :e COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I ` ave . the same fo regi ration, have recorded it in my Lo Record wi h the above stated Registered
Nu n' , .nd on the •'s'. 3.er I HER RANT A FERMI
to ...,� ..1 - . . .. .. . . .. . ---
the / (,.... Addre
... . .. . ..... to hold temporarily n body.
pers.n—fuer havingchar e rpse). :ker or
g p ) (I ove or othe ' sr) state h
Dated y ' ••••-"ew•-• /.,�9, .... (Signed).
.. .. . .. . .. .. .... ... .. . ... ....
oca Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (su ect to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is r quired.
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