Turner, Sovair Form vs.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
LT 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 Re tered No.
n
Dist. No '�7County.: �.,)��-'�t.�'-Z.: 2.4 l or reity i c-�c--c.-..e, c-GG'
- ,/ , (If city, glee street address)
Name of deceased 7- �'�r...6,.. .. .11_/ Veteran
��)) Single, married, widowed, -
(if .ever . mace-name of war)
Sew d ColorIt� r divorced (writ,g a wor ... . Date ofL� ( 19
Age 'd Years 1$ ..IV oaths / PayJ Birthplace...C3 G• .. R.'L. 41
Cause of Death � � •••j -a- �/
Certificate was signed b r r� M.D.
Address /}..rU: ..y 2:Ll.....
Place of Burial .. Removal).... �z: : .. .
(If body is to be te..4 ally be d,fil space late r1�, Jof Burs .,
Cemetery f s,r:iK-'✓I/ll` DateBurial.-1 ���i 19.�S
(If body is to be temporarily beld,fill in space later)
Thq Certificate of Death containing the above stated par iculars, having been presented to me, after careful exami-
nation, the same appearin to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have c pted the same or re stration, have recorded it in my Lo 1 R cord with the above stated Re i ered
Nu o e ' th .ral�I HEREBY GRANT A PERMIT �/,,�
, )7( -''
5/L _. N me) rein)
the !'{ fa!4. :• .....to hold temporaril}}}'''and the body.
(Uri or n Tta rig charge r ) "`� (Inter,remove,or r e die a of[■ b ])
Dated &� 19... (Signed) - c�---r t2e( e .
Local Registrar
This Permit is - fficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other gulations),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
Date o_i LGLi� wad,�// / 19 s
(interment or
(Name of Cemetery, Crematorium, etc.)
Section . ;7 Lot No. S3 Grave No. 3
(Signed) Gig- CdL fJ
(person in charge)
Addressl ib*,Z4-
c L¢_
� .�1{
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 ABOVE 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 ONWENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.