Sawyer, Margaret Term vs.61 NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar This Permit can be signed only 1py 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 DU LE BLACK INK. Town Registered No,,Z,5.7.1
Dist Noh ‘‘)/ County aiii."1.-/ oVriCliagitye
(If city, ve street adtcrese)
Veteran
Name/ deceasedg7:11.. ... . .. . (If veteran. We Toe of War)
IZICiacfied, widow ,
/
S .,.. ,..;.y. /ColorM46,4or divorced (write the word) /.1e.---<:•.reollv-(4172epate of ath 2.. ...1./.4....2. 19
Age I thYae.4. M nths .Da , Birthplace.
Cause of Death-
Certificate was sign . . . .... .- M.D.
Address -
Place of Burial (or Removal)... . .. ... . -
(It body I.to be prart e ,1311 ace later) i ----
Cemetery. .... .. . • Date of Burial 2/1"-/a .7 19
(If body la tobbe temporarily d,till In apace later)
The 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 piepted the sa. e for registration, have recorded it in my Local Rec d w'th th above stated Registered
Num and o is t f 1,HEREBY GRA
to hold
A PERMIT
t '
a ) d s)
the tempora " nd. the body.
(Underta men having charge of corps.) (I ,or°the gnome of Wats bowl)
Dated ,7 .4 1
it
19 (Signed).
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part ef the State (enbject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 52) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of was 19
(I torment or5.sastis4)
Sy / / '
(Name o Ce i y� Cremat rium, etc.)
Section 'Iv"V Lot No. u Grave No.
(Signed) g._ " Q
(person in c arge)
44.5L-116419.
Address i�{�_„, / /X
//(, l'-' ' '
Person in charge oust 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 FUR THE FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.