Parker Jr., James . /7e
Form VS No.62. 7-6-55-1011M(5G153)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
DIV 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
31 )f;erebpCertify that the accompanying dead body of........, fY.Cx�...C.1....C1 L. ,
Veteran* /Le-Ieer.,A. k who died in the
(If veteran,give name of War) (City,P ge or Town) ill
of .. _ ,
dea
x County of State of New York, on /.2/ 19'5.7Sex.. . Zw
C - ��-GX-Y-- Diverted
Color or race , Ageiz tP years months days, Birthplace. and Cause of
es Death �` has been prepared for transportation
:▪• strictly in accordance wi R lation 1, subdivision ./f-- .as printed with this blank. Certificate was signed by
a q�� / ,
h d ,,.. ;...tf .. M.D., Address...!/+ � Date of shipment....11/i)'�
19').. .; Route of shipment t /. oint of
.• shipment G it ; Point of destination , 1..i.2.A.t aefrktY.L.,..
(Signature of Undertaker).W/ �(}_ � /�%..,�.(�f.(. — 14a,
... /� �/.�..... ... ...
—▪ Dated.......... 19-s 7 Address ��%..rd n.."�. .. a�
y 'Cross out words not applying.
PERMIT OF LOCAL REGISTRAR
s DIST. No. / / Registe d No.
ti
3 Date of issuance V ....L.J 19
-.1A satisfactory Certificate of Death for above decedent having been filed and recorded in ofa , PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY. QQ a(Signature of Local Registrar) o .k 1 .
Local Registrar of the - of � .. , County of.: ,
(City,Vikake or Town)
State of New York.
ffilfr Only the Local Registrar (Deputy or Subregistrar) may issue a Burials Removal or Transit Permit
Detach here and give part above to escort or attach to waybill if shipped by express
c -02-e--
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
r Date o z..-,0. e,,_‘7,,.
vas
/72-7, Z/
(Interment or Cremation 1
(Name of Cemetery,Crematorium, etc.)
Section 5 r Lot No / 1-/v. Grave No 11
Signature t--4---42L-gib.-%-:.... 14-4131 ... reyvt,c_. . tfe.,__ 4z-7e:
(Person in Charge) (Address)
_/ele-e-z--, •-.:..41-ii- - '7. ,-27,.
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.