Snyder, Mildred Form Os.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tir 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.__._ .:.L._
Village
Dist. No........6.......County.. G`�l:� . City j.�r s.r
! (If city,give street address)
Name of deceased 2�',a. �� "� � '� Veteran ��-
ing1e, married, widowed, �j (If veterann, give name of War)
Sex ;� 11 r divorced (wnte the word) i 1 6' ft '( Date of Death. Q: 4 / 19
Color ' r �
Age Years _ ?� ,Months `.........Days irthplace... .N. :i: .. -"1j 1i
Cause of Death sta "kJ..r:..z:: €. -re-*:s•s..s...��' 1�. . :,.Zer
Certificate was signed by ...:Lk � . .:_ M.D.
Address 4....,..4.....:17rc.rk� .. .�'1 t ,
Place of Burial (or Removal) r.� ... . . .. .y. ?) ./
(If body is to be temporarily held, fill in space later) _
Cemetery .i/ i. csa..- Date of Burial . . . 19..S-6
(If body is to be temporarily held, fill in space later)
Thq 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
Number, and on the basis thereof I HF.rREBY GRANT A PERMIT d,
to i.... -, �ti. -f 7`c'e ..... c. �—�—�C yr..l
—NN ) Address)
the 1:4„ �Tule. -(--.-- to hold temporarily and , the b dy.
(Untlker or person having charge of corpse) (Intel,rempve,o otherwi dispose of[state how))
Dated '- ... 19 :<.: (Signed) �� Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part 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.
ENDORSEMENT OF SEXTON OR PE )N IN CHARGE OF
PREMISES ON WHICH INTERMITS OR CREMATIONS
ARE MADE
.,�
Irate o '' , -�1�- was '. g' 19(5 �'
(Interment,or Cremation
re L'
14-7--c' -2,—/e 4.—•• v a.0'i ..L e...2 7---i 4-1 i 7 '--&' 27
(Name of Cemetery. Crematorium, etc.) 7
CI
Section35 ,? Lot No 0�0 Grave No.
gn A 1(Si ed) � : y,�l� 2_--L4')L l`
(Person in charge)
Address ( (, G' 6 c 7_4(
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," ald FILE PERMIT WITHIN THREE
(3) DAYS with the Registrar of District in which
cemetery is located
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violati: r "le law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOLLARS
NOR MORE THAN FIFTY DO FOR THE FIRST OFFENSE.
The law will be enfoi ed. Local Registrars are re-
quired, under penalty, report violations thereof.