Schweikhart, Lottie ✓�_ NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
far This Permit can be signed only by the Local Registrar (Deputy or subregistr ) of the Primary Registration District (Town,
Vilrage, or City) in which the death occurred after the FILING and acceptance of a C RRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
5904 Westchester msvirvomicuo Registered Na
Dist. No. County or City ew ttochelle
k (If city, give street address)
Name of deceased LOTTIE SCHWEIKHART v9,114 Veteran no
(If veteran, give name of War)
Female Single, married, widowed,
Fema
Sex or divorced (write the word) ...Q.a,D. Q Date of Death April 19„19 46
Age 1 Years ;Months Days Birthplace New York
Cause of Death Encephalitis ,,
Certificate was signed b Dr , Otto Sommer '\ M.D.
Address 13y3 Park Avenue , NIt V 1jl'l
bn , N.Y.
Place of Burial (or Removal Town of Queens t y, County of Warren, New York.
(If body is to be temporarily he 6,.1i11 in space later) a April l 20
Cemetery Pie View Cemetery Date of Burial p 19 73
(If body is to be temporarily held, fill in space later) .
The CERTIFICATE OF DEATH containing the a ve • ted particulars, having been presented to me, after careful examination,the
same appearing to be COMPLETE, CORRECT, AN ISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with t a ve stated Registered Number, and on he asis therrf bY GRANT A
PEoseph E . Stafford Stafford Funeral H �Home
to 90 Montcalm Street, Lake George, N.Y.
Undertaker (Nned5371 Address)
the to hold temporarily and remove a nc re-inter the body
(Undertaker or person havi charge of corse) (Inter, remove, or otherwt se of (stote how))
Dated 2. p.t.Q/Tiber 19 ..7.J.e (S' +sL b7........ .. ..lr..l�. ee.
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.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of / i , '� _ s '(f` � /'19 7^ -
(Interment or aeration)
. (Name of Cemetery, Creramer-un ::e-te.)
' / i
Section Lot No. j/%' Grave No. /
(Signed)'.
(Person in Charge)
� y
Address ,, A , , ,
l'' 7 7
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 UNDER-
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 retumof 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.