Beaudin, Josephine Farm vs.eL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rar 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.
`' Village
Dist. 1�T0./.1..�.:!/ �r...COL1YSty.L4lJ .e4asAt,._... Of City
(If city, gtcy address)
Name of deceased :. Veteran`
. - of veteran, ive name of War)
//��iritLwIs—gle, married, widowed,
S lork'. , orced (write the word). Date of each...../... 192
Age . ,2...Years.. .Mo ths ... .D s Birthplace.... ...
Cause of Death .
4
Certificate was signed ty/ M.D.
Address _ .... ....,, �.
Place of Burial ( /' Removal) - , �
(If body is to be tem r. ,•4 y I n ce later) /
Cemetery 73e2s.. Date of Burial.. .. .4 19.... 4
(If body is to . temporarily held, 1 in space later)
The Certificate of Death( ntaining the above stated particulars, having been pre--,ted to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTii Y AS REQUIRED BY LAW,
I hay accepted the gam for registration, have recorded it in my Local R ord with th above stated Registered
N , the I .T •ereof ,/ HER '•Y GRANT A PERMIT 413,
(Name) , i , ;(Address)
the 4: , to hold tempora '1 and AP fret. . .. the body.
de, ker or ? charge e.tfX�orpse) 0 (Inter,re..•i . nose of[s to bow )
Dated.... ...19,. k� , (Signed) / ! . (
Local Registrar
• rmit is sufficient for the Removal (and Interment or Cremation) of a body to any peat of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
•
ENDORSDIV4T OF SEXTQN OR PERSON IN CHARGE OF
PRE1ISES )N WHICH INTERMENTS OR CRE4fATIONS
ARE MADE
Date of ))4,.16:-. ,,e- Y+� ; was ' l
., .a(Intolment.or Crejnationl; '�1R
r
` ' .ro
(Name of metery, r1ump etc.)
Section . .#Lot iNd. # Grave I o.
44
(Signed)
y (Person
Address�3 ��
Person in charg must reirn this Permit to.
the Registrar of his District within SEVEN (7) DAYS
from above crate. If no pers s in charge, the
FUNERAL DIRECTOR or UNDERTAXFI JST SIGN ABOVE $,TATE- '
MENT, write across the face oi'the Permit, the rofds;
"No person charge lm-•and FILE PERMIT WITHIN THE'
(3) DAYS with the Registrar of District in which
cemetery is 14cated.
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law r elative 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.
s1