Sullivan, Patrick D frr Form 5%
OF NEW To' .
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BURIAL PERMIT.
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P.^5. 2 The Certificate of Death having been fAzished to me, as :(,:sr.a. e, oy the.La_ zeis of this Slate,
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permission is hereby given for the Burial of l414-
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Sexlikit.. Age ?6A, who died at C2-Ges.--4-4.---v-1..-&----e&—c.... . , in the
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of death being...,18..4.4 .. .--iess,,_ :2-tes-1"7„, Place of bourzat__ a.leAelefill...LAVIelen...4....E:
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• cr.) g„Titi - Undertaker or person t VI.--‘... (Signed by)
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in charge of Burial, I
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BURIAL PERMIT.
Name of Deceased,
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Person in Charge of Burial Ground or Crema-
tory must fill out this part, and file the same with
the Registrar of Health, within seven days after
the disposition of the body.
Date of i Interment
Cremation__ ' —19 I
Signed
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Files 19a
Registrar of the ,74
of `1= = =. N. Y.
NOTE—This Permit is only to be issued for a Burial within the County where
the Death takes place. Cemetery Keeper, etc..must fill out according to above
Certificate. In case no Person is in Charge of Burial Ground,the Undertaker must
fill out that part on the other side of this Permit.
Every Cemetery and Crematory are required by Law to keep a Record of all Bodies
interred or otherwise dimosed of on the Premises under their charge.
BURIAL PERMIT BOOKS, TRANSIT PERMITS FOR CORPSE ON RAILROADS, REGISTER
BOOKS FOR CEMETERY TO RECORD BURIALS AS REQUIRED BY LAW ARE PUBLISHED
AND SOLD BY
CHAS.E. HOUGHTALING,
LAW BLANK PUBLISHER,
ALBANY,N. Y.