Reed, Mary corm vs.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
to This Permit eau 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 CERTIFIC TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.._.... .__ . �
-� Village
Dist. No,,. Z.County...... f...,� or City / .
` - (If city, give Street a dies /
Name of deceased....r.....�id,.i.c '�l /
..� ..�1..,..........��,,� Veteran ,i,
r Single, married, widowed, (ls ►eran. sive name of wax)
Sex.. .%a4Color ' or divorced (wnte the word).... .,r•� Date of De Zr. 19.. r-v
Age...r�'�..�=Y Years Months.. . .....».,.Days Birthplace ... f. ,t '.4'....,/' f,
Cause of Death -9':..�:;(..FGus., - -' * ....,...-C 4./. :.'e.. �! 4.a
Certificate was signed by.. .,,,a jj .. './s1s.-r..:1-.-k....- �, M.D.
Address .:- ..........I .L ( o a�.�r� C� .,
Place of Burial (or Removal) r-�� ..>:w 4� ��...�-=�-�.�ur1�..:;.z ..
(If body 1s to be temporarily belly-fill apacVlater) F
Cemetery C.t,.. :.....�,;;;u‘ • 0000 :, ,., / Date of iurial • ,, ".cl" 19.. ,E
(If body is to be temporarily held,ill space later)
Thq 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, have recorded it in my Local Record with the above sta ed Registered
Number, and on the basis erepf I HEREBY GRANT A PERMIT '
dare..)
the t Z..:.:z. to hold tempt sfly and -a' / e-body.
(Undertaker or person having charge of corpse) ..... ,(Inter,re ore r the di f[state Low))
Dated ,!')P`�L .G 19 (Signed)-. .q ,:a:-:: .�
Local R
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (srbject 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
Date of Internment was Nov. 22 19 61
(Interment or Cremation)
St. Alphonsus
(Name of Cemetery, Crematorium, etc.)
Section 1 Lot No. 1)4 pliggwItia Row M
(Sided) r /( t / •_ Lli C
• (Perso,in charge)
Address ;I
t a .i
Person in charge waist 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.