Higgs, Elizabeth Form VS No.61. 8-8-81-75,000 (17-05u1S)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
WThis Permit can be signed only by the Local Registrar(iruty or Subregistrar)of the Primary Registra-
tion District(Town Willem or City)in which the death Gemmed after the FILING and semptance of a COR-
RECT ANDCBOMPLETE CERTIFICATE OF DEATH,LFr`VR1 Y WRITTEN IN DURABLE BLACK INK.
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Diet No... _`�QQ,j1 Regi o
•
County—Marren arren — _...._ .. Date of Death..A. - --- .-•---(.5—---•19-`3t
Town,Vi1Ciy Q£..•. ens...E&Is,-_.. Sea. _ Age. 4 Yrs. Color-..-.. 1.._
lage,or City" (Or Met)
(If city,give street address)
> reCa rk.
Cause of Death_... ._ ,r _ . ' .—.
Place of Burial(or Removal .-_ „ ..� � .. _._-----....._.. _._.-r•-.-
Cemeteryif
Date of Burial...02 - ..19---
Certificate of Death of..__....__ r Ai f
- <
lye full name of deceased) / 7
having been presented to me con ' ' the above stated particul: and, after carefpl examinationa,,
the same appearing to be COMPL TB, CORRECT, AND SATISFACTORY.AS REQUIRED BY
LAW, I have accepted the same for registration,have recorded it in my LocalRecord with
the ahoy stated Registered Nun,,ber Con, basis th I EREBY A PERME1
(Name on i .
the. _ .- -. ._ .....
(Un t gt or germ lurag charge of Wprase) (In -.,, •• to how) ,
Dated. - ' -- .[.- -.....-.._. I � / (Signed). 1 ► // /�
rt, ,
Thu Permit is sufficient for the Removal (and Interment or Cremation) of a bodyto any part of the
State (subject to looel a atery or other reguiatiups) mawreatooal is by common carr ,in which ease a
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