Bishop, William Form vs.si. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PER
Sr This Permit can be signed only by the Local Registrar (Deputy or subregistrar) the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a C• '0 CT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No. .._...._....._._
)3bilge
Dist. No....153 County..._...A LI:Laliy noty i • •n i e, N- cork
(If y,give street address)
Name of deceased W.ill..i,a(11..B.i.s.k1Ap ... ... Veteran
(If veteran, give name of War)
Single, married, widowed,
Sex M Color W or divorced (write the woe I..!.7.nQJ..e. Date of Death .1.126/ 19 57
Age 77 Years Months....a .:i,: s Birthplace ---
Cause of Death nay•.i.a.c...de.c.omppQ.S 1.. o.o.
Certificate was signed by ......Lame.s...B.a r .' t M.D.
Address. 225 .E'•••s St. ...T ,,y.,...N.ew...Y.o.rk
Place of Burial or emoval �, 411 Falls New York
(If body is to be tem.ors ly held,d in'mac • ter)
Cemetery 't... 01.Q.'.5.e Date of Burial 3/27/ 19 i7
(If body la to be temp.rarily held, • 1 in a• e later)
The Certificate o Death c•ntaining the a•.ve stated particulars, having been presented to me, after careful exami-
nation, the sa . ..e. ' g to be CO 'LETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accept ,e same for regis ion, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereo HEREBY GRANT A PERMIT
to charle.a...B.... ; nn 102 Third St, Waterford,, N,Y,
(Name) (Address)
the unciertak.ex to hold temporan.y and in. - the body.
Dated (Undertakejyor Demon haying charge of`J corpse) �';' (Inter,]m. .�: ,alaro oi5[eta Low
.5�� ll C -�
39 (Signed)_ r' e"
Loc ••tistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Slate (.abject 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 SEX1UN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of �� ..f was . oZ 7 19,$
(Interment or Cremation));"1.
(Name of Ce tory, Crematorium, etc.)
Section Lot No. Grave No.
(Signed) 6i/e.oar
(Person in charge)
Address (3.- O - gcri 6, 0 o LE. � (}a �. .
I J
Person in charge Heist 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.
RENT, 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.