Ginsburg, Jerome Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar This Permit can be sig -ned 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
._ Village
Dist. Ned.2-6 i‘r,‘. ..,*11._�Courty. or City
(If city, give street addree
Name of deceased... Veteran
' I Single, married, widowed, (If veteran, give name of War)
Sex Color b(/ or divorced (wnte the word) D:ae of D ath // — ,5� 19s..s:.S—
Age Years .g7--' Months crti.._ .Days Birthplace It:e /
Cause of Deaths
Certificate was signed by .,G,.. „¢ M.D.
Address i *-mac---.......It.. . .
Place of Burial (or Removal)
(If body is to be y�mporarll-y he 11 space let
Cemetery*�r�K ....I. .. .. yY, reC..'r.. Date of Burial....1 / - G 19.,.A:.1'`
(If body is to be temporarily held, 1 in space 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
Num , and on the sis thereof I HEREBY_ GRANT A PERMIT
to
//„.. 4._.e.......2,L...
the (Name) ( (SddresQ
to hold temporarilyand , .the body.
(Undertaker or peJson having charge of corpse) (Inter, remorWhe2e chino of[eta o )
Dated'....1 / - 19..f.7J." (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any peat of th (subject 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
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
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Date of ! was )I / 191 S
(Interment or Cremation)
(N of metery, Crematorium, etc.)
Section Lt No. Grave No.
(1.11L—'
(Signed)Lam '"K-4
(Person im ¢harge)
Address 1
U •
.� J��(
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from above'date. If no p on is in charge, the
P 1?FEAT. DIRECTOR.tazti [INAEEWC .MUST. SIGN..AAOVE.-STAT& ..m,..
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 ONru,NSE.
The law will be enforced. Local Registrars are re— !
quired, under penalty, to report violations thereof.
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