Camp, Baby Girl gwm.r3 Ple.'01.- 5-5.51-7D.UW lii-aauo!
NEW YORK STATE DEPARTMENT OF HEALTH
•
OFFICIAL BURIAL (OR REMOVAL)PERMIT
aa'TThis Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra
tion District(Town Village,or City)in which the death occurred after the FILING and acceptance of a COR-
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
'Dist No o/ Regis No.
County-_ v'._._. Date _._._._ /f I0 Z
Town,Vil-. a TW CXgtt-a -
'age,or City- _ _ _ .-.---- --- Color ���
(If city,give street* l •
Cause of t)eath..---- ,, _-- �.-_:
Place 4Bwi f(%r` emoval) _-.-_.... ;�` `"" •
Cemetery...- 'r• Sri � --4-4" +-.,Date of Buria // i 2-
5-Certiflca.t of Leath of E' . �D
Grive full name of deceased)
having been presented to me contai ' the above stated parti s and after careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I have accented the same for registration,have ecorded it in my Local Recor 'eh
e above 's ed Nu y_a on the basis I HERESY ..P
( g�bf Un )
the a.
- _ to -
(Un or person ha se); (In or of[
DatedMC
- _.._.._ I (Signed). 1�-:-r1--- L -:_- -- - - ----
ocar
Th remit is sufficient for the Removal (and Interment'or Cremation)of a body to any pert of the
State (subsect to local cemetery or other regulations),unless ramosal is by common cam,In which ease a
Transit Permit(VS No.(12)isramlire L
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