Matott, Frank NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Fr' 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.
Dist. No...3702 County Oswego or City Oswego
(If city, give street address)
Name of deceased Fr..ank...R......Mato.tt Veteran
(If veteran, give name of War)
Single, married, widowed,Sex male or divorced (write the word) wid iwer Date of Death .. 5!/
1 1I 1970
Age 81 Years .Months Days Birthplace N,Y,
Cause of Death Acute respiratory failure
Certificate was signed by Roger C. Cook M.D.
Address Oswego
Place of Burial (or Removal) GlensGlens falls ,N.Y. P.inevi.ew....Cem
(If body is to be r -i.l he fill in space later)
Cemetery �121eview h
em. Date of Burial 5/13/ 19 70
(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 Charles H. Loescher
er Oswego,IN.Y.
(Name) (Address)
the . funeral director to hold temporarily and Triter the body
Dated(Undertaker or person dhargeloof vo�pse) _,(Inter,'remove, o th rwise di pose o �r tate how))
(Signed) : ::.......................,.
L cal Reg/ rar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the Sta e (subject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) i equired.
FORM VS. S1. (REV. 6/63) (9A2-205) •`,- .'•0
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of '"C:21..tG G 44"(was 57h 44/ /3 19 7e)
(Interment or—C-f - t'-n)-
(Name of Cemetery, C ,
/Or-GGi —1r \�i4
Section Lot No. ,l' ' Grave No.
/d v ''�/I�L-it�--
(Signed)
1,/ ' (Person in Charge)
Address
r/eac,
./4„, tifi k
Person in ch must return this Permit to the Registra
of his District within SEVEN (7) DAYS from above date. If
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.