Crannell, Julia L', or VS-a1. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 Registered No._ ._..__....._._
Village
Dist. No..:S-4"`i County..... . `- -`-7 or City .._, . ( , ("Kr, '" 'r
(If city,give street address) r'
Name of deceased �/.--.t'rt.--'�----4 -.- Veteran
Single, married, wido , / (if veteran. give name of War)
Sex... �; Color �j or divorced (write word) -.-t-`--, Date of Death..4d,,./. - 19 % Y:
Age J.h Years. Months .D s itrthplace
Cause of Death J
Certificate was signed � �'`�- - M.D.
gn try.,,. .
Address = ,
Place of Burial (or Removal) L.
.�:: , t ;..{..s . . ... "r r~
(It body is to be p rarfly fit,d1.ln spa 1
Cemetery e = u` -4- ( 'G , 5m- : L.. Date of Burial a- - 19.4.
(It body Is to be t por ly held,tl 1 s ace ter)
The Certifica I of ea c ' ing the above stated particulars, having been presented to me, after careful exami-
nation, the s e appe i to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accept th for registration, have recorded it in my Local Record with the above stated Registered
Number, on e sis thereof I HEREBY GRANT A PERMIT E r /j
to � ®® :i.� 4 - V °-,\-, 6z. fg4 —-
the Get-)1ra4-,2--,= to hold tempo arily and � "�-?--- 7-, the body.
(Undertaker or person ha ng charge of corpse) ,(Inter,remo o herwi a dl ose of [state how])
Dated � ..c 19.6- is (Signed 'e::/-t,a^-�, .-,- ..-r--`
Local Registrar
This Permit s 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.
of 4,4
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of was� !f�� 79
(In Lenient _ Crematl )
1:1;-ZZ'
(Name of teas tery, Crematorium, etc. •
)
Section Lot No. t Grave No. .
(Signed) �CLi...-4 ��+'
(Person in char e)
Address e..% iii-9y44.1 � 161-
,e
A.f y
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 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.