Theoliold, Thomas DEPARTMENT OF HEALTH OF THE CITY OF NEW YORK 1 HH-36M-811061(75)
1 7500 BUREAU OF VITAL RECORDS 346
BURIAL-CREMATION-TRANSPORTATION PERMIT APR 1 8 mix
Date
The Certifico of Death having been nished to this De artment, as required y the- ealth Code Qer fission
eby given to G' --":_er.,.- 11'7� _ fjtl _ 1 . .L_ /e/
remove the remains of _._.. _ ....._...._.__ __ __Age / Yrs. ____. _Mos. Days,
a died st<%k _... .....' _....._....._._ _.... Borough of Manhattan
y of N��ew. Yore n� 9_.�_. p P
Burial*at_ __ .. fizA/f_ed -�'t�Y' 7
on 1 f 9
77- ill
s permit must be handed to the Keeper
the Cemetery or Crematory by the
oral Director in chine of the funeral. ,b{ Registrar
roes out one. Per_.._ _.._ „i°? ._ �_