Beut, Charles r��.•J.,,.. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
re-This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra.
tion District own Village or City)in which the death occurred after the FILING and acne of a COR.
RECT AND Q1A .ETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE ME INK.
Dist No.. Registered No.
r�► ...__...._ ._.. ._
County a rre ---..__-__=_ _ __ Date of Death...&C......x2_..V_ I g Town,Vil . }ty� r y
lags,or City-1 `__II 6it_a _.Fa'i- .:. _744- e-7 Z Yrs. Color•._
os.)
at city,give street ad
Cause of Deatb. ..24 _._. .--,. ._ -
Place of B ' or Removal). il
-LEZ
Cemetery.- _ / -Date Burial- 5.�3 I"/
Certificate of Death of_._.. __ . - __ _�.--_-•---
(Give full name -deceased)
having been presented to me containing the above stated particulars, and after careful examination
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I ve accepted the same for registration,have r riled it in my Local Record with
the ab stated RegistV N , don the balls th I YNo �IjVTA
tO
..
the....._... , _ to......-__ _1 i .'_... # .the body.
r or person wing charge of c'8Ie) (In :• •� to bow)
Dated-- ---.-.- .__:_-g ------19. /1 (Signed) 'i r/> ,k. Try -
Local .gistrar
This Permit is sulReisnt for the Removal (and Interment or Cremation)of a bed to any part Odor
State (subject to local cemetery or other regulations),unless removal's by common ,in WWII ossa a
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