Bennett, Winifred NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rir This Permit can be signed only by the Local Registrar (Deputy or subregistrar)of the Primary Registration District (Town,
Vilrage, or City) in which the death o rred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DUR E BLACK INK. Z
— Town, Visage Registered No. J
Dist. No. i f S6 a. County... .1 �GT : 6-, oaown, -
• (If city, give street address)
Name of deceased Car„1 _ Veteran
Y (If veteran, ive name of War)
Sicz.-r-il gle, married, widowed,
Sex 1C ,c or divorced (write the word) ...1r1;. l �-Q6) Date of Death -3.....):-.. . 19 .7
Age Years Months — ''Days Birthplace 4,,,i.. . .6
Cause of Death ..''....v....
Certificate was signed by /! )...... `2 M.D.
Address -3.p8 / �/l Place of Burial (or Removal) .... . -
(If body is to be temp held it i .4.--ram.
n spat r
...:.
Cemetery --�� � � sy � �/ �, !.. ate of Burial ... 19 7�
(If body is to be temp illy held, it in space r)
The CERTIFICATE OF DEATH containing the above scat d particulars, having been presented to me, after careful examination,the
same Appearing to be COMPLETE, CORRE T, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have ded it in my Local Record •ith the above stated Registered Number, and on the basis ereof I HEREBY GRANT A
to J .( in O't .�... C'..�[ / 6 !/I/4 1Z d�ressf.' ..aive°1-1 ,231(21a:kr
the Cam" v -1 to hold temporarily and / the body
(Un'"jrtaker�or pgrshag charge of corpse) (Teter-e�tt9� ^ is e af (state how))
j/ I, r o
Dated 3. .._•3......7k 19 (S ,ti
Local r
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the tgate(subj lito 1Ta1 cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit(VS No. 62) is required.
FORM VS. 61. (RI V. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date ofC le:4 -6 as )1(44/ ` 19 2c-C
(Interment or
(Name of Cemete Ere atonum, etc.)
Section 4,91 Lot No. ‘;'7 Grave No.
(Signed)
(Person in Charge)
Address / ��� i
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 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 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 required, under
penalty, to report violations thereof.