Meyer, Paul NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
i
is ' 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. % 00
Town, Villa !�2e to o.
p �f
Dist. No.Jv 4' 1 � Co my..1�,,%(�:tr�Pr..:1,,,.1 or Cit "�7 `��� � �/ � �
(If city, i •e street a dress)
Name of deceased �`^� ` Veteran i/
(If veteran, give name of War)
Single, married, widowed,
Sex or divorced (write the word) . �1./(!V' Date of Death s 19?-
CCCC .. C
Age ./ Y ar Months .... Days Birthplac
Cause of Death ( s ......... ... . v . \J
Certificate was signed by "--4 J M.D.
Address . c - , '
C.'
Place of Buria Remov '` ��•- 4
(If body is cob porarily a d, fill n sp ce ter
Cemetery �- ,, •. a �� Date of Burial t 19 2
(If body is to he temporarilytemporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,the
same Appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, a recorded • • my Local Reco d with the above stated Regi red Number, and on the basis thereof I HEREBY GRANT A
PE A T N
to r.t.- K.�
(Name)J _____,
the .... to hold temporarily and .....:........... the body
(Undertaker or person tng charge of corpse) (Inter, remove, or dispose of (state how))
Dated .. 7 19 2.i (Signed) ........... .
Lo
This Permit is sufficient for the Removal (and Interment or Cremation)of a o a ft to ject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit mit(VS No. 62) is required.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
( 2 yN ^J
Date o was 19 /`-S
(Interment or
tl .f --il_` V -to-C-G
(Name
m of Cemeter reatorium
/
Section t%- Lot No. 7 Grave No.
i
(Signed) " ,t,t/
(Person in Charge)
Address / d.
� ��`-
Person in charge must return this Permit to the Regi r
of his District within SEVEN (7) DAYS from above date. I
person is in charge, the FUNERAL DIRECTOR or UNDER
TAKER MUST SIGN ABOVE STATEMENT, write across th ".-
face of the Permit the words "No person in charge,"
FILE PERMIT WITHIN THREE (3) DAYS with the Regist
of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERTAKE
violating the law relative to the return of permits are liable tS ;
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.