Stein, Myrna Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ThIs permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
V' City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERT T OF
b . LEGIBLY WRITTEN IN DURABLE BLACK INK r Town Registered No
Dist. Nei 6 Gl County..... ...»...... o4-1,--*--,, �C .<_ a.. ../. _
(If give street addre
Name of deceased i Veteran
,. / Ingle, married, widowed, (If term, give name of War)
Sex ... olor / - ...or divorced{(wnte the word) ... ate of Death.RCll--C-r../0 19�
Age 2. Years Months... .....Da s • Birthplace
g att � Y P
Cause of Death
Certificate was signe b .... ... ... .. .... . .. M.D.
Address `
g • - A
.y
Place of Burial or Removal)....
lit(If body 1s to rarily he]+�o ;n space later)
Cemeteryate of Burial...... — / 1947
(If body la to be temporarily held,811 in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above tated Registered
N 4, , and on the b sa p thereof I HEREBY GRANT A PERMIT `y�
the / /,�, (Na ddress) k
.v 41�h,.� to hold temporarily and t oy.
r., ker or person having charger corpse) (Inter,/remare r disnose of[etattJow
Dated..go ..... ,.. .// 19...2...J (Signed) y .) :> :f: 'i'd °-';..,.�- _,�;.r-,`
/ Local Registrar u
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pert 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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date o� • Jl�F•��i �" f was ��4i�•C- . `,--" 19
(Interment or Cremation)
•(Name of Cemetery, Crematorium, etL.)
Section T �� J�i� �•` 'ot No./1 Grave No. 2 -
/
(Signed) [%- , _ �." �G? ? II
(Parton in charge).
Address _,� ." Zyt� �f' /
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from above date. If no person is in charge, the
FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, 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 re-
quired, under penalty, to report violations thereof.