Cronkhite, Frank Form S's:vz—» NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
zr 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.
TVw.l Dist. N rf.Count .. Village y , c4;:€411, ,o f
� s If citg, give street address)
Name of deceased .. ... . .. .. 67_4„,-..f .dez ......
Single, married, widowed, �1
Sex.. . .- Color.. 1_..or divorced (waste the word) Date of Deatltl�C � i.�1 7 6
Age... Y Months / D %s /Birthplace
Cause of Death.... . ../.... ... _ ,
Certificate was ' ne by... A, -... .... .. .. , • M.D.
Place of Bur. or Removal) '� /- 7
(If body is to eerily held,fi I :'ace later) w
Cemetery.... ... . +`i e/
K I mo• •• • ••• Date of Buria:.. - '... - 19?
(If body Is to be temporarily held,fll' space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to he COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW.
I have acgeepted the same for egistratign, ha e��••ecorded it in my Local Record wit e above stated Registered
Nu �,hand on th ba s ea GRANT'A PERM!
to.. . .� " "sue -'� Z7•.r
the •� a (Name) v_ (Address)
to hold tempor ily a d the body.
Undertaker or pen having charge o eyrpee) nter,remove,or othe Is lose of(e e h )
Dat . .. .. 19... fl (Signed) t.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a y Ito any part of the State (subjec o local
cemetery or other regulations), unless removal is by common carrier, in which case Transit Permit (VS No. 62) is required.
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