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Gratton, Edward Fora vs.aL NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT n 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 CERTIFI TE F DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._... A `/ � Village Dist. No,,.1..1�4./..County.........�:�1,✓/e,..i.A.4-N...) or City -- ... .. .. (If city,give t addree�) N. .f deceased Veteran in le, mar Ili' r veteran, give ame o War) // g Age i /olor.h r divorce (wnte the wor . G 4 G.,e,,e� .Date of De / -...19... .,1 �.,3 s Months ...Da s Birthplace _,,��,, Cause of Death.... .. . . .... .... .. Certificate was signs .. n/ M.D. Address...,, •-e4,,,, , , Place of Burial (or Removal .... ...i� w a,� (If body Is to be to rily held in pace I r) Cemetery z .� -�.�' �..Date of Bu al 7��'1/K 19.�,1 (If body is to be temporarily held,AI space later) Thg Certificate of Death co taining 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 Nu , and on th b, sis f I HE Y GRANT A PERMIT to. .. .. .r ..... .EZ.�. ..... ., th •• ) to hold tempora�rily-and eaa e body. or person hay' charge of corpse) J, (Inter,remo,e,or otherwise dlsoose of(state bow]) Dated J 19....�o.,/ (Signed) _..:. - c. , < __-,';744,1. ,. . >....... al This Permit is sufficient for the RemovalRegistrar (and Interment or Cremation) of a body t any pert of the Stab (s+.bject 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 INTERMENTS OR CREMATIONS ARE MADE r. ' Date < _ ,5 19 ( / (Interment or Cremation) pp `% (Name/jf Cemetery, Crematorium, etc.) WA'ip.Es P. G Section Poo 81 e Lot No. b Grave No. (Signed) •�G Per on in charge) ifQ Address V , Q . !n • 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 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.