Eades, Wilfred Form Os.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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.— .V.._._.....__
S Village &eliegfria- 1 4/
Dist. No 'G 4� County.,. �`?? - or City
(If city, give street address)
Name of deceased eg,d6f.e" Veteran s
`�,� Sin e, married, widowed, of veteran, give name of War)
Sex ',.` I......Color..., or divorced (wnte the word)) Date of Death 9/ ? 1951
Age 7/ Years Months... Days Birthplace
Cause of Death
Certificate was signed by Q, .&-e�� M.D.
Address . . �„ -� Lj. LJ -
Place of Burial r Removal) ,/.. .t/ 4 / �j. •
(If body Is to be p &rily held,til in apace later)
Cemeteryt...rf�-a- 1.1�c.�t/' (-K.Rn, Date of Burial / 19..�5-
(If body is 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 accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, .•• on the baaisereo� I�-It�BY GRANT A PERMIT
to
/..„% (Address).r...........
the.... -e-r- to hold tempo ily nd. .. -��-- �.--,-" the body.
(Undertaker or person paving charge of corpse) • (Inter a or�o ►e dispose of[state how])
Dated S/ / 197 (Signed .... (///
Local Registrar
This Permit is sufficient for the Removal (and Interment or Creme 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.
1 'I
ENDORSEMENT OF SJ!X'IUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
7.
Date L (rc 11.-t- J ' was 7C 192,
(Interment'or Creme flan)
7 - '' / ' ' ( -__
„ .2"/_.„-c- _2.714.51--'----{"le#.4
(Name of Cemetery, Crematorium, etc.)
7 •
Section Lot No. f1 Grave No. r
(Signed) . ✓ -vb�-�t-
(Person in char
Address / 1. ---05` 6----k� ' -' -
Person in charge Dust return this Permit 7
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.