Beckowitz, Hyman Form v&6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or This Permit can be signed only by this Local Registrar (Deputy or subregiatrar) 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.
IVo.LV...County. .. _ Village
��• or City ��
(If eity, give street add' "—
Name of deceased .... .. Veteran
'` ingle, married, widowed, -
(If sterna. 6iv name of War)
S . .. r divorced (wnte the word). - r6 19%.c.7
.. ..Color... .. Date o e ..
Age Yea M(Ilt s Day Birthplace...... ..,
Cause of Death r �./ „..
Certificate was signed '
MK, •
Address .... o'' -.i j .... .
Place of Bu ' 1 (or Removal) 4'!
(If body is to temporarily -9Yl ,,� a later) / 1 `
Cemete :,it,,..../... •, . '- Dat of Buri `,C.� ..
(If body o be temporarily held, . in space later)
Thn Certificate of Death containing the above stated particulars, having been par,- ed to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFAC. CRY AS REQUIRED BY LAW,
I hay ccepted the same for registration, ha e recorded it in my Lo ecord • the above stated Registered
Nu , the bats. t I HERE GRANT A PERMI
to . . . ..X/7::
xa ) (Address)
the .. .44....rr•- to hold temporarily f
.. .. . .. t the body.
taker r pe a haying charge ,pgtpse) ter, • en f [state bow])
Dated . . i 1 ,. (Signed) lo:. ..
Local Registrar
ermit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ("object to local
comet* 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 .1( 4-1-44--Littwas , ..1,9 _
(In-termen 4r Cremati ) � _.
}
SjC1-4°vti)`�
(Name of Cemete y, rematorium, etc.)
Section Lot No. Grave No.
�'� L—'
(Signed) D-7 - "�-`' Cti�
gf
(Person in charge)
Address !
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 wards
"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.