Frasier, Eva NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ram' 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. 5.j��
/' ' Town, Village 46.„2142;giste
Dist. No� ° County WLi1/t �ih� or City `c �. v •�}
(If city, give street address)/ •
J---
Name of deceasedg.1..1.7-a, , Veteran !!!
(If veteran, give name of War)
/� gle, married, widowed, —y� - q
Se .•••,•�--'M.eeL or divorced (write the word) :.GA- Date of Death') ,u'7J `� 19 .1.s"
Age �d Year Mo hs Days Birthplace !/.
Cause of Death .. 7 ..
Certificate was signed by liii.yZ...r. Orkl_. - M.D.
Address p ........ ✓.... ) +�?�X,C=�
Place of Burial or Remova
e ... :-�,�.s �.... ..,
(If body is to b� mporanly e)d, i 1 in s�� (/ .
Cemetery .- ..(..12 4:(1.!....... Date of Burial 19 yj5
(If body is to b temporarily eld, fill ins a 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, have corded it in my cal Record with the above stated Registered Number and on basis thereof I HEREBY GRANT A
PERMIT /
to �/h°`' 2( �l- temporarily ,
the o to hold temporay and 21OY
(Under ker or person having charge of corpse-}— (Inter, r o (Adhressj r other i e dis�o�sjeof,(ystate how))
Dated `}.Zc.- .) •a 19 7 5 (Signed) L 1 frgi,tr
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part 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.
FOltM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date o ` r`.,•J was i1--e-72
(In to rme ntsiar4
fee
(Name of Cemetery, Crec.)
Section Lot No. Grave No. v
(Signed) v`
(Person in Charge)
Addr
Person in charge must return this Permit to the Registrar
of his District within SEVEN (T) 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 Regfttsar
of District in which cemetery is located. ¢^.
Y
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liablt,t6
a penalty of NOT LESS THAN FIVE DOLLARS NOR MO`
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, un „er
penalty, to report violations thereof. �`