Putnam, Bessie Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Sir 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK iNK. Town Registered No......g ,...c-
A"-- C./ Village
Dist. No - , County L2.41:2-joad.,
•-• • • or City ‘ ,.2:. /a.:i1.. 1-e‘.%
(If city, give street address)
Name of deceased .g,.-ea.--ad-W..-., (?..d..d.--2-7 Veteran -rkz...4._...-
Sex,/ Color.i77.474.oSringilveo,rmcarri(edwn, tweidthoewwedo,
rd). i"-..,-Xakafzri.Date of De cif vete . gi name of w.,),4
Age 7.3....Years,* Months.... ...............Days Birthplace...4
Cause of Death Ca-ra — .... .7 '
0::2,c,,e., .
•
Certificate was signed by ,of . .. M.D.
Address .444-w-- r-1 Place of of Burial (or Removal) ,
(If body is to be temporarily he. 119 in space later)
Cemetery "-').447 77:...e1-.. .. -0:4 .. Date of Burial il/...)....4.0. ./
(If body is to be temporarily held,fill in space later)
Thn Certificate of Death containing the above stated particulars, having been prese fed 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 registration, have recorded it in my Local Record with the above stated Registered
Number, flon tlztasis th f I H REBY GRANT A PERMIT
to
.-.------. (Address)
the hold temporarily and. the body.
(Unde r or pe having (In.charge of corpse) 7inzrep o A/Air/. Boole>/latate howj)
Dated Z../ 190-7 (Signed)
This; rout is s dent for the Removal (and Interment or Cremation) of a body to any part of the State (ustbject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
C°-�J2 C2eZ
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PHEW SES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of was L-�/j e) 19
(Interment o on), /
(/
Cf7.,./4.07L
(Name of Cemetery, Crematorium, etc47
Section 7 Lot No. 2 Grave No.,
(Signed)
(person in charge)
Addre SS l Y/i 4 `��x rt 11 yj 4
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 UNDERTAKEN 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 FIRlST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.