Suckman, Abraham NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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.
f� , / J -„ T was, Village
Registered No. /r,
Dist. No. '-✓<0 /,)i my . ✓�' '� '' o ity
(If c• , give street address)
Name of deceased (,:1,r"✓ f.,( ..Veteran ...2 C.�
(If veteran, give name of War)
r� r / Single, married, widowed, • 3 c
.. g (write ..fn...0,q,,t,: 1 Dat of Deat ,r.192�
Sex ._. or divorced the word) \
gg
Age -' Ye s w .Mo s.. } Day irthrlace ' 1 .. c,..,&.:(,,
�pp
Cause of Death ..,f',IZa.!/l. -,/.n "-- 'y,-'-il y.- ...` ^'.� , ,/L�'
Certificate was s gned y ,,'t-ti.:.._...b.... .....ri,,: i, ' t. .. .; M.D.
Addr ss . 'Y` � z�� J
Place of Buria Removall ,'„1,,.. .�(,y..�,.e ,� C. rl_.ab,
(If body is to he a porarily held, fiLLGa sfa ter)
Cemetery ::...,, �.L,L L/. �.. . r Date of Burial {i 19.75
(If body o h temporarily herj, ftliin s ce later) '
The CE ' FICATE OF DEATH contai ng the above stated particulars, having been presented to me, after careful examination, the
same ap-ring to be COMPLETE, CORRECT, AND SATISFACTORY AS QUIRED BY LAW, I have accepted the same for registra-
tion, ha recorded it in my Local Record •'th the above stated Regist r d Number, and on the basis thereof I HEREBY GRANT A
PE•MI 4 1
N.
Nam .-- �f"
Aa�ie s} r
the 1 � .
. ./..k.. �'/.7 ..-tl .�?...,� to hold temporarily and ` �. .,,....., the body
(Un erta•er or person having charge of corps -- ter, remove,'otherwise dispose of (state how))
Dated 3— ..A 19 .../....rJ.... (Signed),/ �/
• L o c" 'aTR c'n,44,
This Permit is sufficient for the Removal (and Interment or Cremation)of a bod o 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.
FORM VS. 61. (REV. 6/63) (3A2.3231
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of,..) was '—" 19
(Interment or Cremation)
1
(Name f Cemeter Crematorium, etc.)
Section Lot No. Grave No.
(Signed) � 6 '7 2 1-4:Y -?( ,I C. (_ 2Y7 ., c c_
(Person in Charge)
Address /�,•-- E. 2 , r'f1'`' . _..;
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 UNDER-
TAKER 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 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 required, under
penalty, to report violations thereof.