Lockhart, Frank NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
iltr 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
LLATH, LEGIBLYC ITTEN IN DURABLE BLACK INK.
Dist. No.tJ ..i,.... 7. Registered No.. _...__.._._....
Town
county. ,. .G_G 'Sal !.___ ._ ........___.___. ...._.__..__.Village.
C Ilf M. aiv not .thus•
tat
Name sod''f... 1 d. ._._.�c y fG __._ ._� _ _ ^- r
6 le, n rued, widowed, � �i —
S / Colo Ivor ed (write the word)/ ltr. SkGr I Dea,tpya �/'lL_19_ 7
Age... �.____Ye ��..._.....__._..\lonths_._. ._._._..Days Bi hpla .� /1✓tt'sd
Cause of Death _ S
v
Certificate was si n by ._._a.__ __ __....__._..�. 'Cr_ —M.D.
Address.... _. _._._. __.__._. —�
Place of Burial (or Removal). _ —.. _ _ --•
(If body is to by t city hold.�tt a •Imo
Cemetery_ Z�-�`y I _._...___Date o u / 19.31
(If body n rari to b• tempol sold. du apace lost) —___._.
The Certificate of Death containing the above stated particulars, having been p sented to me, after careful examina-
tion, the same appearing to be COMPLETE, CORRECT, ANI) SATISFA ORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record the above stated Registered Number,
and ontto - t o thereof I REBY G ANT A PERMITL �d{.. —
��r�aes/!A Nose #qio _ p( .Addeo*). .
the O'_barr. .&._.to hold temporyt and. cif-,1�", the body.
( stare«c« hz,.stum r ) / * diem; of fete bowl)
I)ated.r�_ZC % / Af _-19 (Signed)-:..... G
Led R.ww.t
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pan of the State (subject to local camabey
other regulations), sinless remora( is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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