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Fitzgerald, Catherine Form Fs.aL NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tT 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 ATE QF . DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._-.. ' ...Q 3294 Dist. No County ONEIDA Village or City MARCY • (If city, give street address) Name of deceased... L 71, - 5L2..1,diLds Veteran 7 - • n —Single, married,widowed. r (If veteran, given a of War) SeX .e , ' 44..Color�'�` r divorced (wJ ee tkle word).4�T 67 Date of Death -�' t-t- . 4 C 19 P Age 4 4• ear ..td.cog.g Month g..»...Day t Birthpl 4 vi ... Cause of Death_ ...� a.. 4°,:ex .e p C It- ,�.it-e at 0-t .9.ct-�' -P- alx' ..... sal, Certificate was signed by l..t)L t...: ,. M.D. Address is 4,4 ` 1 e•• / qL •% (jiff Place of Burial (or Removal) ,•„ (If body Is to be to rily held,flU in spa ater) 'l Cemetery ... .. .. . . ....,.....a. Date of Burial ..... - il,..{ 19.,5'�� (If body Is to be temporarily held,fill in space later) Thn Certificate of Death containing the above stated particulars, having been presente to me, after careful exami- nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I ha e accepted the same for registration, have recorded it in my Lo I Record h the above stated Registered Nu , and orihe b sis t I HEREBY GRANT A PERMIT ,- to.... . G� 1. •...... . . . ) (A reas) th • • •••�•.•.•••• .•• to hold temporarily -rd the body. (uplertaker oriereon having Li charge�of/corpse) (Inter,remove or of rwlse is e of[state how]) Dated .::.. ...lrt 19a�,.. (Signed) O e put y I.oc egistrar�L •" This Pert6it is sufficient for the Removal (and Interment or Cremation) of a body to any part of the date (aubje,^t 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 INTERMENTS OR CREMATIONS ARE MADE Date of . �i t.i e - -1, was ("GG` ",^1,,, 19 (Interment or Cremaihwj • • (Nose of Cemetery, Crematorium, etc.) Section ?-7 Lot No. 67"-glif Grave Nog `y e (Signed) / G G'22- (Person in charge) Address 7.1 f ~ L -' (47 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 OFFENSE. The law will be enforced. Local Registrars are re- quired, under penalty, to report violations thereof.