Vogel, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
far 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 COMPLET CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. of
giste d No
. C Villa
Dist. No.. �1 .. County.(be%G. or orTown,
City... ,
/� 0 / (If city, give streee ddr )'
Name of deceased , ....a,e�`� /'� Veteran — - -,�..-
(If veteran, give name of War)
Single, married, widowed,
or divorced (write the word) ....... . .. Date of Death 'c2.c'c 192
Age L) Y ars Months Da Birthplace , ,
Cause of Death ....... ...
Certificate was signed by .... .. ... .. ......c M.D.
Address � . . .... .
Place of Burial (or Remo al
(If body is to b�t,�*iporart he (i in space at )
Cemetery .y ;liL�..1.......... Date of Burial . -- .9
(If body is to he tempor i1y hel , fill in space later) 19 ...
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same 4ppearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, - ve recorded it in my cal Recor with t above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PER
to ,, ) ..... �,�/ ..
( ame) / / ( ddressS
the .......... ... to hold temporarily and p L the body
(Undertaker r ersor\having charge of corpse) e , remo or otherwise dispose of (state how))
Dated — cr.`.o- 19 72, (Signed) HOC#.t- =
Locz.Regigtrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body t any part of t,.e State (subject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM VS. 61. (}tFV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of was c2 19
(Interment or Crematio
(Name of Ce Eery, Crematorium, etc.) /
Section P D Lot No. / , Grave No.°
(Signed) _
( erson in Charge)
Address 3sr4 ) 461-11.9 )).4.14��Jl Y
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above date.lifjo
person is in charge, the FUNERAL DIRECTOR or UND
TAKER 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 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 required, under
penalty, to report violations thereof.