Reardon, Charles NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
r 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. '/
Town, Village Registered No. ��37
Dist. No. (, 6 i County ��--7&- — or City i 4'
fi J (If city, give street address)
Name of deceased .. Cc�!r`, C1.1.f .:r. ��—� Veteran
(If veteran, give name of War)
Sex �2 Single, married, widowed,
i� or divorced (write the word) lG Date of Death G G 19 9'
Ageu • G, `r Yea Mont Days Birthplace V`LE t?�� •
Cause of Death i. �. ... -�7�,� -/�-'
Certificate was signed by .��Yf 44e...,..,..7 /y!„e777� M.D.
Address �-t$i tZ �t'�,i(yJ.
Place of Burial Removal) ,7 O> -- , •,1- .e—✓/'
(If body is to b1 orarily held fill,}rf space (ata�} �,`
Cemetery Burial.
"u'- L-k=as2- Date of Burial Lt42-'- 1 19 90
(If body is to he temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same Appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra•
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
/ '/ ( amen (Address)
the '� to hold temporarily and L, the body
(Undertaker person having charge of c v
rpse) (Inter, re oe, o tse dis ose of (state how))
Dated % 19 7L (Signed) .. .
�/ Lo al R istrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a dy to a y part of the tate (s ject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Perm t (VS No. 62) is required.
FORM VS. 61. (REV. 6/63) (9A2-205) 91
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
'l
Date of -4-4-iC " was 7 "7/ 9 19 2'
(Interment or CYtrmatrerb)
(Name of Cemetery, Ct_matori,..n, e .)
A/4,41;e1e4feiej
Section Lot No. 6 �'/Grave No.
(Signed
(Person in Charge)
Adds fii(61
` .
Per /Vi /
charg must re urn this Permit to the Re ' rar
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and
FILE PERMIT WITHIN THREE (3) DAYS with the Registrar
of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.