Smith, Henry Form VS No.62.
10-18-54.10M (4C-58)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
Jur A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany
each dead body transported by a common carrier.—Regulation 1, subdivision 1.
UNDERTAKER'S CERTIFICATE
3i iberebp Certify that the accompanying dead body of Henry..R.-.i mi th.
Veteran* Peace time who died in the town of Canandaigua
(If veteran,give name of War) (City,Village or Town)
Countyof Gntari0ngle*
, State of New York,on Sept.,S�ptr 28 19}�...,Se1Ia7 tw, �;►i�?�l
aVIM/41.
Color or race W Age 52...years 4 months..22 days, Birthplace Water.1ford,NX_ and Cause of
Brain hemorrhage Death !� has been prepared for transportation
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strictly in accordance with Regulation 1, subdivision 2A as printed with this blank. Certificate was signed by
tisS. Pillar , M.D., Address VAH„Canandaigua,NY Date of shipment
"� 19 ; Route of shipment RAILWAY EXPRESS AGENCY ; Point of
x shipment Cananda N, Y
• p Canandaigua, t ; Point of destination... Glens•F� 8.1, .5 �� X,*
.T. (Signature of Undertaker) ( ,
Dated Sept. 28 1956 Address.. . NQ MID.I ..St.. Cananf a .N....Y.
c *Cross out words not applying.
PERMIT OF LOCAL REGISTRAR
3
DIST. No. 3498 Registered No. 23
a Sept.3 Date of issuance 28 1956
A satisfactory Certificate of Death for above decedent having been filed and recorded in my o e, PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY.
(Signature of Local Registrar)... . ao,
Local Registrar of the town of C , County of.. ... ta,11,Q
(City,Village or Town)
State of New York. 1
Only the Local Registrar (Deputy or S bregi✓trar) may issue a Burial, Removal or Transit Permit
NW" Detach here and give part above to escort or attach to waybill if shipped by express
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of ' ,. 4 Yn was 0.d 19!1T
(Interment or Cremation) -
(N a of Cemetery, Crematorium, etc.)
Section ...;t 711-1-'14"4"---
� Lot No. t�.� Grave No
Ate-
Signature let/ GL,t�/n 82-441--ce. V. ...6 0 4 ~
c /
(Person Charge) (Address)
Persons in charge must return this Permit to 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 STATEMENT, write across the
face of the Permit the words "No person in charge" and FILE PERMIT WITHIN THREE (3) DAYS with 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 required,under penalty, to report violations thereof.
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