Mead, Huldah NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
B?Thia Permit can be signed only by the Local Registrar(�ty or Subr�eatstne)of the Primary T -
tion District own Villars.or City)in which the deathafter the FILING and acceptance of a COIL.
RECT AND CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN DURABL BLACK INK.
Dist N - Regi No.
County dlYLj D of Dee
Town,a ' . -- �e a_.)Yrs. Color
(If city, street address)
Cause KDaath_-_____.._...__.
Place of Add Removal). ......... - -. — ---�/
•
Cemetery._,�(1,.,,•.i Rd[.c_. -tLl.4.4?—.-_ _Date of Burin + I}-l./
c
Certified* Death of. •_ -
. �-- _
(Give full name of )
having been,presented to me containing the above.stated and after careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW,<I:have accepted the same for registration,have recorded it in my Local Record with
the VistaAV ' feted N ber and on the buffs I Y IT
)
Dated-_ '/,+s. s_ i93J (Signed). p .or '�• I bowl)
gistrar
This Permit is sufficient for the Removal (and Interment or Cram tion) of a body to any of the
State (subject to local cemetery or other regulation.),.unless removal is by common carrier,In which caw a
Trans t Permit(VS No.8ii)is required.
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