Nadeau, Baby boy S.sL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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 CERTI`I OF
DEATH, LEGIBLY WRITTEN IN_DURABLE BLACK INK. Town Register d No.
Village
Dist. No.. 111..:Q County , or City ���/�
(If city,give street address)
Name of deceased ),,, Veteran
o
� S le, marri , idowed,
, '°•/• ..
(If v ran, give name War) ,////
Sex.... .. Col .. . .... i rced ( •te the word) Date of . ...Zee._ .•, .... 9...Fb
Age onths. ... ys i Birthplaee....
Cause of Death. . / ,. . ., .
. .. . . . ......... . . . . . ... ... . • . . . .
Certificate was si e
Address
Place of Burial ( emoval) „
(If body is to bet rily held,?space later)
Cemetery ,A.. 2G ,- /..,.,C ,--4'V Date of Burial e- 19i4
(If body is to be temporarily held,fill in space later)
The,Certificate of Death containing the above stated pa iculars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accept the same for re ' tration, have recorded it in my Local Record with the above stated Registered
Nu . .�y , n e basis t I HEREBY GRANT A PE
dd )
the . .. . . . . ..... ...t to hold temporarily the I ty
( taker or a aving charge oficorpse) (Inter mov otherwise of[s how])
Dated...G.Z -,---5:� 19... "b (Signed)
.„` ,► lLocal R
This Permit is sufficient for the Removal (and Interment or Crew tion) of a body to any part f the State (subject to local
cemetery or other regulations). unless removal is by common carrier_ in ..4.61, ..... . Transit P...n,it (VS N. R21 is r.nu6..1_
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