Bayle, Evelyn NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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, Villag Re • tered . ,,iOd-)
Dist. No.,..C6°I County. ait.4.4,-/ or City e (7,
Name of de ased r Veteran( city, give set address)
-)
(If veteran, give name of War)
Single, married, widowed, 61-a2 /or divorced (write the word) . Date of Death 19 "J
Age Y ell .Month ays Birthplace
Cause of Death
•
Certificate was signed by e M.D.
Address
Place of Burial ( r Remova .
....,. ... ... ..
(If body is to be to rily fill space later , ....
Cemetery Date of Burial 6 ---...,/ D 19....2,,,
(If body is e temporar. y held ill in space later .
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me,after careful examination,the
same vp.j?ing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, hay. ecorded it in my Local Record with ,t above rated Registered tuber nd on the basis thereof I HEREBY GRANT A
PERMIT
247
....,;(Kress C94(& i i
•
the . .MIKPM to hold temporarily an the body
.(' erta or person having charge of cor
) ( r, remomr otMea.jsce of (state how))
Dated /
4/ f 4,19--- 19 /3 (Signed)
Local Registrar
This P/iti is sufficient for the Removal (and Interment or Cremation)of a body t any part of the State (subject to local cemetery or
other reg ations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
POrtm 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 was ` 197 3
(Interment or Crem ton
kkA0 64/Ural
(Name of Ceme ery, Crematorium, etc.) v
Section x ) C' Lot No. Grave No. + X
(Signed)
(Pe son in Charge)
Address c3 I tY "41 /ih1 0 9 j�►
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 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.