Sleight, Edward Form FEL 61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gr 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 CERTI E OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.....Z-
Village --
Dist. No"i-&-f 7County..../..../...2 ce-14-311---"--'1 ,er-eity .....„2-1.---1----CL
Name of deceased gct.,,,:. .4 ..„..1...ziZ-e ' (If city, give str dress)
Veteran
fiviaingle, married, widowed, , (If veteran.Ave name of War)
Sear/Al...Color. . .. . r divorced (write the word). (4./4/7%-/-1 Date of Death. 7 J 19.6./
Age 7 Years Months .— Da§s BiTtliplace.44/... ... . . ...a-Weas,.7.2)4 ..
Cause of Death 6!...v2...izee,___,Lace .il_e_e_v_Aa4,4
Certificate was signed by 3-.4---- - r i --la ,1.4. .--/ M.D.
Address .. '7" (..
Place of Burial (or Removal) 7. (.7ii-P49-1/ ----t -1-zif c. - ,
(If body is to be temp91 rily held, In space lateprl..,
Cemetery -e--(4. c--e--e-etz 41/;/, Date of Burial itli./C 3,e 19.6./
(If body is to be temp ly held,tin in space later) ,
Thq Certificate q Death containing the above state4articulars, having been preente41to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTOR AS REQUIRED BY LAW,
I have c pted the same for egis tiôn, have recorded it in my Local Record with the above stated Registered
Num , _ 3 p‘ n the basis th f tgiry11--GRANT A PERrT
C1 -'till
.,.. 4..1'6 0,t37.5retkie
/
the i /144(t.GL.-/M4t to hold tempora ' and dress)
the body.
(46yik firperaon baying charge,f s 0 r pie) (Inter,remove,or othe se dial) me of(state how])
Dated 19 6,-(
(Signed). ,.r
74IU TLL
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) 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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTEB&IENTS OR CREMATIONS
ARE MADE
Date of �� [.c �� r was
(
(Interment or Cr
��
,T (Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
(Signed) �l✓r.. 7t ��Y �/..-f,(
/ �(person In charge)
Address /l /� �- • i ✓'� 1-� -:-+
Person in charge Gust 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 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.