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Irwin, Eva NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT Qgy— 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 CE TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town, Village Registered No. Dist. No. 5726 County Wa511inotQn or City 17 LaClai.#'.e Street (If city, give street address) Name of deceased Eva M Irwin Veteran No (If veteran, give name of War) Single, married, widowed, Sex Female or divorced (write the word) Married Date of Death Feb. 26 19 70 Age 77 Years 0 .Months 2 Days Birthplace Sandy Hill. N.Y, Cause of Death Cerebral Apoplexy Certificate was signed by John McCann M.D. Address 37 Maple Street Htttison Falls N„Y, Place of Burial (or Removal) Tw.(a....Qt;,e. nshu.ry Warren co N.,Y, (If body is to be temporarily held, fill in space later) Cemetery Pine.vi View Date of Burial .F,eb.....2e 19,,.70. (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 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 toCar.letn.n 'u.per.a.l...Hone....Inc......(.A..c...W<.1c.on) . Hud5on r ail ...NO/. (Name) (Address) theFuneral Director to hold temporarily and . Tnter the body (Undertaker or persotl having charge of corpse) nter, remove, or t r ise j s of (state how)) i 7 Sr Dated Feh. �, 19 ..7..© (Signed) �.<!� '�'�' , g Local Registrar �:� / � This Permit is sufficient for the Removal (and Interment or Cremation f a body to any part of the State (subject ocal cetletery'•r other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. FORM VS. 61. (REV. 6/63) (3A2-323) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE _,_, ,,,n 7----._ A ca.:--e‘:f ,.. ,r/ /--„, Date o was 19 (Interment ,r €re -` (Name of Cemetery, , Section '*-•. ` Lot No. ie-'Grave No. .4 , (Signer •l ei IIJ/i.� --(Person in Charge) Address *J Pers ' charge must return this ermit to the Regis of his District within SEVEN (7) DAYS from above date. 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 o^f 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.