La May, Elizabeth M7 -mes -- 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 Registered No—....A..a... ._ ....
Dist No.4.-.‘al County... /f.....4-22re""r Village .,,,...e.40r...,e_ (7.4...ze......
or City
Name of deceased 4Jre 7/i`47
,_ 4.:(1,i. (If city, give street address)
Veteran -----
ingle, married, widowed, / i . (li veteran, give name of War)
Color..... --- or divorced (wnte the word) ' .Date of Deatb ....-/P.-......19-51
AV
Age 4 ..5— Years i Months .....-- Days Birthplace .--- ....44.t. .... ..gee ...7afr...
Cause of Death W
Certificate was signed by C . ...::<4...ffit-t-x.-- M.D.
Address pi' a.‘4 y
Place of Burial (or Removal) /...0.-m21..... ...*:...... ...,,,....4,40,-,,....a.. . .... . . ..................
(If body is to be tern • ld,ill in ace later)
/
Cemetery C.arsa...A.. Date of Burial --.I."/ A,....S 19.rd:-/
(If body is to be temporarily h/1(.11 in space later)
The Certificate of Dea . 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 acceped the same for registration, have recorded it in my Local Record with the above stated Registered
Number, ,.4.. Xee...basis th f I IFIERk,BY T A PERMIT,4, ,
to .f.... 4..c.......
the 3r.W-4-JZI.a.)
.-.-froc- to hold temporarily And . the body.
(Undertaker or porno having charge of corpse) ,,, ' (Inter,retsove,gjother,eri seipinose of(state how))
Dated 0 .2 a, 19....X.-7 (Signed) - - - ' ,r..:-:....;'.;....,..... ...../ -- -,*---,,
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pail of the State (mbject to local
cemetery or other regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
—1
ENEORS MENT OF SEX'IDN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date ef�;�I;�,1� - .:,._ was l,a ;r..3 19 N
(Interment or Cremation) //
(Name of Cemet , Crematorium, etc.)
Section '' Lot No. ,4!.. 1 Qlave No:
i)
(Signed) (1&/*Pata6ii,,,,_ .(person in ...arty.)
,'i- 6- A_' air ,
Address ,
)2(c___,..,_.,., d),___,.c___€...,, , .,)1___,__7,
Person in charge mist 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 SICK 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.