Berkowitz, Hannah NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
f 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 Registeredr No. 36,/
Dist. No. `s�'0� County e/ n- - or City ,i4C/t-twJ X
Ajz...z...4...w.: (If city, give street address)
Name of deceased .1Veteran .71-27
(If veteran, give name of War)
Single, married, widowed, _ 3
Sex Q ^ or divorced (write the word) .. ,....Date of Deat / 19 .740
Age .Sr Years Months Days Birthplace. .
Cause of Death ~. ... ........ .......v!. . . ,
Certificate was signe�b� ... �'��-�-�-�r�/R� ���t M.D.
Address y, fj
Place of Burial (o Removal .
(If body is to bet p arily he d, fla.-.rR—sp tl er)
Cemetery / 'L Date of Burial � '. / 19 ' 6(If body is to be temporarily h d, fi11 icpace 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 Lo 1 Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERT .
to
(N e �Addr6s5
the to hold temporarily and the body
(Undertake per on having charge of corpse) (Inter, remove r otherwise dispose of (state how))
Datedwry ./ 19 .�d (Signed) 2.5
Loc I R istrar
This Permit is sufficient for the Removal (and Interment or Cremation)of ad o ny part of the tate (subject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM VS. St. (REV. 6/63) (9A2-205) •.4,.-.6.-•Q