Schwartz, Philip NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rair This Permit can be signed only by the Local Registrar (Deputy or subregistrar)of the Primary Registration District (Town,
Vilrage, 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. a �w
�� Town, Village ReL No.
Dist. No. Q/ County f:R./L4r14-tiri or City
QQ (If city, give street address)
Name of deceased 7� Veteran
''� (If veteran, give name of War)
jy , ,,,. or divorced
rred, widowed, �� S Y a-�`,.3 19
Sex or (write the word) ....... Date of Dead),
Age..G..... .
g �i G�ta Years..,. 1'2 ./....Month Days Birthplace
Cause ofmeath '. 1.44 .
Certificate was signed by r •
M.D.
Address
Place of Burial (or Removal) .... 7....
�J �. '. Le....
(If body is to be temporar held, (i in spice l t � �'�hryG
Cemetery7— Date of Burial s- 41-0 19 „3,,
(If body is to he tempor rily held, fill n spat later)
The CERTIFICATE 0 DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same Appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT •
at
(Name) • .....(Aa. ressS
the to hold temporarily d the body
(Undertaker or person having c arge of corpse) (Int e, otherww'sse di ose of (state how))
Dated 3"" a / 19 �?_,j. (Signed) • �t.P.L.__,
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the 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.
FOItM VS. 61. (REV. 6/63) (A2-248)