Seelye, Elwyn Form VS No. 62. I1-57.10M (7C-44)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
Dom' A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany
each dead body transported by a common carrier.—Regulation 1, subdivision 1.
UNDERTAKER'S CERTIFICATE
A I Hereby Certify that the accompanying dead body of ELW.Xi...E......S^ ' E.
Veteran°.....ND who died in the Cityof ..White....P.laine ,
;q (If veteran, give name of War) (City,Village or Town) tingle*
1 County of IiLe.S.tcheos.ter , State of New York, on.....IICC......28., 19...59. Sex..Male., ,l
Warren Ciuuty, 'We've&
b Color or race—White...,Age 75 years - .months - days, Birthplace „ a and Cause of
Ai- Dereth :.:f :..z. a ion. -Mis een prepare for transportation
strictly in accordance with Regulation 1, subdivision II as printed with this blank. Certificate was signed by
." lia 'tita 11Q a ' '- .D.,Address.. X5 2.1. , ,43Nhi.+�ate of shipment. IX-3 O
��,' 19..1.; Rou of shipment. i , ; Pointin of
shipment. ; , in satin ion .!,�?.e.�,s'�:ym, • ..�Q.sM.. :imr. Q. N.i•
B (Signature o Undertaker , mac.' .. JC Re o...`�.--itizp G E. Dated DeC• 293 19..59. Address
*Cross out words not applying. N
R PERMIT OF LOCAL REGISTRAR
k DIST. No. 5902
Registered No. 6.22
Date of issuance De.Q.e....29», 19...59.
A satisfactory Certificate of Death for above decedent having been filed and recorded in my office. PERMISSION
IS HEREBY GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY.
(Signature of Local Registrar) - +
Local Registrar of the City of klhite...P.lains , County of WLatchb'.$.t .); ,
State of New York. --,_
(City, Village or Town) y
ire Only the Local Registrar (Deputy or Subregistrar) may ' sue a Burial, Removal or Transit PAWS
'a,-- Ur Detach here and gi part above- +- scort or attach to itcaybill if shipped by express:
o 11- .�' Jib f s, „
t
1
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF -PREMISES ON
---WHICH INTERMENTS OR CREMATIONS ARE NUDE`
Date of. �; was. tir �t�F� s.�,1 19 ,0
(Intermentonf
_ , 7 a
:::41
26 1 e
' 5"gld / ' . , ,
..y�.. �} (Name of Cemetery,Crematorium,etc.) ~,
; .. -
Signature .. .. ..----11.---'1 4(A.4.74'
... . ...... %/f
(Person in Charge) reL)2'�'u"/
•
Persons in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from a y
date.
If no person is in charge. THE FUNERAL DIRECTOR OR UNDERTAKER 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
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.