Beaudet, Nancy Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
• OFFICIAL BURIAL (OR REMOVAL) PERMIT
rr 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 ORRECT AND COMPLETE CERTIFICiy E OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Al • :(9°
Ala Registered No. .,/ 0
Dist. Ned'" '� Coun ��% /... G./• .ki�}age2�..� •
itv (If city, give street oidIress)
Name o' deceased
Sinnl married, widowed,
A .. to ii divorced (write the word) t�L � to of h. 0.19
for .��r dig
.n7 Months O" Days . Birthplace.. / ,4"--"Y.,
Cause of Death w
Certificate was signed by..... .... ..FI - o . '-1.1).
Address ... 'Place of Burial (or Removal) ,r�-d • _ ...e='p, ,)"j,
!51
(If body 1s to bet rari e S in pace later) (y
Cemetery..,.. Date of Burial ....tl • is-
(If body is to be temporarily he , fill to space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COM• ETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accep d the same for r 'et•: ion, save recorded it in my Local Re ord wit the above
stated' egistered
Number, an on the basis t� H�• B GRANT A PERMIT
C��- %�f�
to •
(N e)
( )
the
•• •••• ••••• hold temp rl d .... tl-iE. body....to or perssuing cargese) r, reDated . 19...(..:.4�' (Signed .. . .
1 Local Registrar
Thf Permit is sufficient for the Removal (and Interment r Cre tion) o a bo to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a ansit Permit (VS No. 62) is required.
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