Berkowitz, Joseph !!!IliksAm NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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, acceptance of a CORRECT AND‘COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No—_. ..i..
Town
i Dist. No w' County ,, sli11: ;t Village ur ,,,.n`, iola
y cll./ r-or City (If city,give street address)
Name of deceased v 0 s c.,N L• -er.4 V ..i sL
Single, married, widowed,
Sex...t+ .J�. ....Color .::tit e.or divorced (write the word) .11::,, 'r i egl Date of Death D%C• 19..+.
Age Years Months Days Birthplace
Cause of Death PPVZC1 I'-i,+:1.t.ci.I.;Q ...r.i.;.t t 1.? : `t— "v n G ,uy,v P.,-. '41.t :.;
Certificate was signed by -*t A • 1.39`,: Zii$ M.D.
Address 'r a..i;z';:acr:n,. -' V a_-a..
Place of Burial (or Removal) r r R. ................... . 'AYt
(I!body is to be tempciyarily held,fill in space later)
Cemetery „ .:71'g. ` z. :a. .T .;..,1 , Date of Burial '''g a4ilh:e 1<..hW .:,. i.9...«. .
(I!body is to be temporarily held,fill in space later) -/ c.
The Certificate of Death containing the above stated particulars, having been presented to me, after careful-ki-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY_�.tl ,
I have accepted the same for registration, have recorded it in my Local Record with the above stag Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to ~-y4 .Y arc rt.4,X"1) t.Z j,1...r. .i.1.1; ...�
(Name) (Address) -
-, ' '' r " "e to hold temporarily and fin,r 1:C ..the pd
the (Undertaker
.persono ing Po y 1 :+er o e of i► '' i�}, y.
(Undertaker or hiving charge of corpse) nter ova other disco=• atHta h ��)41. f
Dated r C :Kn l c.r (Signed) , � .t+ . r
Focal Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
`emetery or other regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
ert-
rag P.
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