Colburn, Celia NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rjr 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village Registered No.
Dist. No. 1953 County Greene or City Catskill
(If city, give street address)
Name of deceased ....Ce.li.a....M......Mi.c..k.s....Colburn Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the word) Widowed Date of Death June 7, 19 70
Age 81 Years Months Days Birthplace New York State
Cause of Death Cardiac & Respiratory Arrest
Certificate was signed by Paul Snapper M.D.
Address S. Jefferson Avenue, Catskill, N.Y.
Place of Burial (or Removal) Gl _ _s,ues- 1, 'r ZT.7
(If body is to be orari�,`- held, ill in space lactee1� yl X
Cemetery E....Elbe-view G�emetery Date of Burial June 11 , 19 70
(If body is to he temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to John J. McCurry Catskill, N.Y.
(Name) (Address)
the Undertaker to hold temporarily and Inter the body
(Undertak r or pers.on having charge of co,,,,r,,,,ppse) (Inter, remove, ,otherwise dispose of (state how))
Dated June ,.... 19 70 (Signed) ...../ T�'L a, ' —
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the State (subject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM VS. Al. (RFV_ a/aal toe,.,nw1 . n
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of a '6s 1 `19 .
(Interment or
(Name of Cemetery, Cre wPtiivim.rreye-
Section �l Lot No. /10 Grave No.
(4%1(
(Signed) 7,A
(Person in Charge)
Address e/ p4�
Person in charge must return this Permit to the Regi rat
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and
FILE PERMIT WITHIN THREE (3) DAYS with the Registrar
of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.