Goldman, Abraham Form vs.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 4M'
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. <----Town gistered No—...,/......*!..../_
— V-ith%e
Dist. NosC667,Z.County...2--)......-- ...... ... or City .... -(_-,c7 a-Pc--1-.Z
_..„ ..... ...„,
(If cit3, give street address) ---
Name of deceased - Veteran Z,C.) //
/ /
Z."
, Single, married, widowed eteran, give name of War)
Sex '71 Color "---/ or divorced (write the wor' (I Date of at 22
14fr,„./a;e190/):
Age.. / Year Months..
Cause of Death . (_, 1
Certificate was signed- -._., ::,u -v,- M.D.
Address Place of of Burial (or,Removal) __...e,
(If body is to be tempo rily held,All in"7"---;_r!) r
Cemetery Date of Burial ''''1-- /7 19.67
(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, h v recorded it in my Local Record wiqi the above stated Registered
Nu and n the l'ihpereof HER GRANT A PERMIT
/ V
..--„.....,, ,.. _,,,..), to hold tenparilFnd ' (Address) (( --, .
thCVdy.
°Taker or yir having champ!corpse) '(Inter,rempTe,Wevrkee dis7‘of[state how])
Dated / 19 (4'7 / ,..._.
(Signed - ( '
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (setbject 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 PEESON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date ofal-tv•A:1_ was "� �; r`1, 19
(Interment or Cremation
LLi . •
(Kase of Ce ery, Crematorium, etc.)
Section Lot No. Grave No.
(Signed) 4,-- a Q �
(Person in charge) _
Address r� ')i "'tiL1*h
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.