Weaver, Julia .., .
Yoram is.IL NEV4",ro:1:: STATE DEPARTMENT OF HEALTH 579,7
0.71,7ICIAL BURIAL (OR REMOVAL) PERMIT
or Ms Permit can be *41514 only by the Local Re-istrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death eecnrreil after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN Dur.AmE CLACK INK. Registered No.
Dist. No. 1401
County of Erie, City of Buffalo
Name of deceased.... .. _ t---' . ...)k-ft.4,2-4-)1,-i::.. WL...)--e (Street Address)
Veteran
(II veteran. give name of War)
--• W Single, married, widowed,wordy. . 1.1
S CX1. \'-r-7: .44..^- Color. or divorced (wntt the word k ti( • Date o e (:(5), 7 19. )(
Age j 'Z'24---.Years e Months lid..-. Days irthpla
Cause of eath U"-t-r-orefukt...- °
- - -1, .t-. AA-43
Certificate was signed by.. ... . .4.-., Ri...e.L.D44,1„.4...,M.D.
Address , ,,
Place of Burial (or Removal)cf.4, ka, ,„...,0 a,.....,...• fil-&-t,-,-, -9---A-Lcc Ty91---,-,4-.6,-)
(If body Is to be temporarily held,1111 In space later)
Cemetery ' Date of Burial C3 c-r- /0 19).y...
(if body la to be temporarily held,fill 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 greceptecj the same,fpr registration, have recorded it in my Local Record with the abov stated Registered
Number;-- the basitikthgria. 4 I HEREBY GRANT A PERMIT --)--
, t. 6 C't--0-,e .
to 1/14 ' f tot-,
dr P11
i ame) itiL-TI (Address)
the to hold temporarilfland the body.
ndertaker r person haying charts of corpse) Xr,remove,,Tothe se of[state bowl)
Dated. ..t7 19 (Signed) ii/-
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any peat of the Stets (wohject to local
cemetery or other regulations),unless removal Is by common carrier, in which case a Transit Permit (VS No. 62) is required.
E OPT':+':T OF SEATON OR PERSON IN CHARGE OF
PRi I SES ON YYHI H IY1'!i:-LE TS OR . i . TIONS
Date of 7.2 -1-4—.:..t" was / E' C 19.�_.7 .
• (Interment or Cremation)
f ^1 /
(Nam of Ceme Cary, Cremes Corium, etc.)
j
a
Section Lot No.� -51'- Grave No.
(Si :,ed) ! -/c -&a(., t 1,..�- 2 (
Person in charge)
L ` " /
rd,d.ess U 6 ja y , /+ ., >
Person in charge must return thi Permit to
the Registrar of his District within 'EN (7) DAYS
fr a•above date. If no person is in arge, the
F±.'_ .3L DI EC'TOk or UNZERTAIER fIIS't S GN ABOVE STATE-
o: NT, write across the face of the Pe 't the words
"No person in charge," and FILE PEiTHREE i:4I WITHIN TERM
(3) DAYS with the Registrar of Distri t in which
cemetery is located. I
1
SEXTONS, FLNE UL DIR.GTOFS and UNDERTAKERS
violating the law relative to the return of permits
are liable to a penalty of NOT LESS 11U2( FIVE DCLLABS
NOR If CF2 THAN FIFTY DOLLARS FCR TM FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.