Bates, Frank Form VS.8L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir 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
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.._... _.....__...._.._.
Town
Dist. No5651 County Warren. —Village- C414WR1 .
or City (If city,give street address)
Name of deceased Frank Hates
w Single, married, widowed,. d
Sex l[ Color or divorced (write the word) widOV►!d Date of Death Feb 1O 19. :3.
Age $9 Years.....10 Months 15 Days Birthplace QbeatertAin, Ka..
Cause of Death Coranacy Seleeo its, D}• ' o Anorlal Sammetie
Certificate ways signed by Floyd kalutir -- -- -- M.D.
Address Q'lena...Falla,...CI.
Place of Burial (or Removal). d'lil o Falle., ,Now... ork.
(If body is to be to porarilyAeld,fill in space later)
Cemetery Fins a,.Rw Date of Burial Feb. 20th, 1943„
(If body is to be temporarily held,fill 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 stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT v
to NailP. Tripp .l.rk 441 .... .t
Underta.&er (Name) (Address)
the to hold tempor ily and ._ in. r the body.
Undertaker or person having char of corpse) (Inter,r e, otherwise disooae of
ggg'' p ) how])
Dated Fab atiat 19..4.3 (Signed). �� t. ..
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part 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.
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