MacLaughlin, Laura Form vs.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tt This Permit can be signed ealy 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 Registered No.�..__ 1
�/ Village
Dist No .`�C c/ County... /.1..�»� 2 :h r or City �: -• '/< Li..
�. (If city, give street address)
Name of deceased da-.4..-‘,--.'i.-.1ihe lL.C..L. ....7C. , Veteran ��j—
Single, married, widowed, //� (1f veteran, give name of War)
Sex Color /�/ or divorced (write the word)..J(P C"r: ,.. ...Date of peath .... 2- 19..,5.- '
Age Years Mo ths ;....Days Birthplace k -i . . Etez-T
,
Cause of Death t... . :'::: -
Certificate was signed"� ..: ger -- _..
.. �-� M.D.
Address ....i ,__� ... . .. ..•) �. r, .
Place of Burial (or Removal) 7-.E'' ' ,2 �s�.4-:€ rra. j
(If body is to be tem ore. 17 held,IIll In aDaee later) /
Cemetery .. .-�. <�c. -4, _ • �kt l • Date of Burial / ,,ill 19' -'
(If body is to be temporarily held, Jill in space later) /
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number ot# 't�he basis thereof I HEREBY GRAs�r+�A PERMIT
to .2 �2 iZ -- °.., .,,7/ ..:...,n.-�%l...i.-..1. �:L... . ,�rL� ;tl° - - —6 y.... ,
(Address)
the G .1,G:r 7 .. to hold tempor 'y a d...,..J. e the body.
(Undertaker or pe.. a having eharg,of corpse) (later, ove �n� , osse of[sta1,11)r w.
Dated / y 19.-.. (Signed)
.. . - t` /_ /`e",— -,
! Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (*abject to local
cecnntery 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 o g.,=7 was /- 19 V!
(Interment oration)
(Fame of eTerTy, Crematorium, etc.)
G
Section Lot No./Z- Grave No.
(Signed)
(person in chars
1.4 Address (/ _h
Person in charge oust 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 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 re-
quired, under penalty, to report violations thereof.