Levine, Ephrent Forn3 vs.GIL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 Registered No._ 3/.2--
Village z z
Dist. No (County .....County... Z1.-...azz-ea,... or City -/ViC-e--Z-2.4?:
(If city, give street address)Veteran
Name of deceased .4.-i:-'-/4-7-e-i--71--1 /-e---ve-4"7-1.
(If veteran. give name of War)
In, Single, marriN ed, widowed,
Sex.2.k2e4-4. Color./..er .or divorced (write the word) -27-;4,-12--el Date of Death e---c---,7 2--,,.: 19 -5-C.-
Age 7 Year Months , ays ;,c-4( --
Birthplace .X.1.41-74-e-- ,
Cause of Death -C . . .. ' ... ..„.j.:c..-g..,.... ... -.C..........C.--.--Z1-4;-- --pf
. .. . --e-- ../..C.:k1'. .e.i:c.i..-, -r?"
Certificate was signed by g. . C A/.411.Z- M D
Address --.-<1 i%a .. (-el-cc_)q.12 fr'
Place of Burial (or Removal) -,,7
f 44E",-- et4./.1 -.14,-z.--e-f-A-7..). )1..-7 .
(If body is to be temp yly held,filyin spa ,zri.,)...e...., z 7 ,,.....
( r)
Cemetery 4 -ke1..- (...ipyi . Date of Burial s....,'‘. i-i- el 19 4—'5
(if body is to be temporarily held, fill in spa later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Numbers:Xon the basit,the7f I HEREBY GRANT A PERMIT
to .1:4-.4.-ki:.4.. r-- •:./ .4'"2.;:7---e-IA,.ii,--di.(-;:-'-i,..1. --.2-'---i';-c4- ),24/
(ylme) (Address)
the Z- 24..e:Li.,.- ..- -.6te.-x--- to hold temporarily and ,. ...- the body.
(Under ey or person having charge of corpse) Ittaemfer othe se disnose of[state bow])
Dated &v.-. 3 c' 19 .-,- (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (stubject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREtifISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of 1 was044,f 30 19
(Interment or Cremation
' .
(Name 6 Ceme.t6iy;-Crematorium, etc.)
Section Lot No. Grave No.
(Signed) ` ` \`I1/42;': r L.o '�1.�'�
(person in charge)
l l
Address ,, h
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from above date. If no person is in charge,'the
FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOtE STATE-
MENT, 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 re—
quired, under penalty, to report violations thereof.