Lamont, Earl Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fjr 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 CERTIF,ICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town egistered No*. 7 Z.
county. "i/.-. ovricnagitye „447.4.0
Dist No.. ,
(If city,give street address)
Name of deceased Lv:'" /7/1- Veteran r--"Preet
Si
SexA (If veteran. give name of War)ngle, married, widowed,
i.. olo .. .... .' or divorced (wnte the word) Date of
tity.0
Age. ....; Yeajq Mo s .._..Days... Birthplace
Cause of Death V.
.
Certificate was signecl by... . .. . M.D.
,
Address _....4.
Place of Buriy Removal).. .A pace later) ....Ait.„4 "...‘...... .,---11 -
(If body is to be te arity-iteld,
Cemetery A--4-44.4., Date of Burial. i "V/..P I 19
(If body Is to b emporarily held,All in space later)
Tha 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 gistration, have recorded it in my Local Record with the above stated Registered
Number, ' th.),,sis f I HE EBY GRANT A PERMIT
4471
,
tO .......i: • • I. 4
dier, , Address)
the to hold tempora ' a.a. ,,. -.... state bow])
body.
turi.goie or pesnrIng charge of corpse) '- _41171,1k-AT,erwlse ,'nose of[
, 4, _....,- f Dated i ..2./.1. 19 (Signed)
dr . al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (eubject 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 INTE IMENTS OR CREMATIONS
ARE MADE
c.._."Et--.`z ,
C C
Date o �o.. a --+.,�/ ' wash._._. <e_ .J / 19 vA
2
(In terser:t or Csesaiion)
7\IL/76:,ijsAL__812_,) Ijr%_-. ,
(Ndse of Cooke tery, Crematorium, etc.
Sectior 2 ` 7 Lot No.cf/' Grave No.
(Signed) Xi t .� C�-1 a(c{`
(person In charge)
Address 7 ' �-„W
Person in charge waist return this Permit to
the Registrar of his District within SEVEN (7) DAYS
frean 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 OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.