Lee, Norman . . .__._.___ __ __ NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Pa-This Permit can be signed only by the Local Registrar(Deputy or Su istrar)of the Primary Registrar-
tion District(Town y or City)in which the death occurred after the FILING andacceptance of a COR.
RECT AND COMPLETE CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN DURABLECK INK.
Dist No. -'
�� .�. _ Reg No....
.—.........—...
County warren...._.-.-- Date of Death. .. _ 934
Town,V4- Cj ..
lage,or city-
9 {t'nS di3S, Sea. / ASe Yrs. Color__
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Cemetery KatA _ ' ._._--114164441
---.----•--_—___ Date of Burial __ _ _r9 .,
Certificate df tltvf---- -._ 4+ d ite
(Give full name of eceased)
having been presented to me containing the above stated particulars and, after careful`examination
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS R UIRED BY
LAW, have accepted e same for registration,have recorded itin my ord with
the a+ e . 'e • - . Number,and on the basis . .` I H ' GJAJ4 A PERMIT
to. - i
/ AV 'c - __ , Jr Address) .. __......,
the t _ to.... d
Vi , the y.
Dated........ ' or _ ying charge ) (Siga )II / - , .. on,-, ,
/ Local Registrar
State bjePermit Isind ufficient for the Removal (and Interment or Cremation) of a body to any part of the
Transit Permit(VS in 62)is required.other ), unless removal is by common carrier, in which case a
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