LaPoint, Francis Fenn vs.st. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 CERTIFIC�ITFOF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.__.._....
/ l Village
Dist. N�„/Sd�? Co ...... . :'. a�ri-�-r or Ci
j..1 J, (If city, give str ad ss)
Name of deceased. : .. ... ... .a..... `-� Veteran ...
/ �/�Single, married, widowed, 2 (if voters awe name of War)
;: 3
Color...4..,,/ divorced (wnte, Y Mon s ...._... ys Birthplace. ..
Cause of Death....
Certificate was signe M.D.
Address
Place of Burial Rem val) r ...
(If body is to be to o eke,fi I ip of later)
Cemetery.... .." Date of Burial 4` 19...1�/
(If body is to be temporarily hel fi in space later)
The Certificate of Death c taining the above stated particulars, having been presented to me, after careful exami-
nation, e same appea • g to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I hay ccepted the same for registration, have r orded it in my Local)Re rd with t abo e stated Registered
N ' , and a has' th f I HE BY NT A PERMIT
. ... . . . . . .. , A et
/ N ) (A ress)
tht to hold temporarily and the body.
(U a ter or perso suing charge of c rose) (Inter,remove,or otberwl state how
Dated.... ... -f,.XC...... 19.ha..j (Signed) " G: — 1 ZZ::
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the ,late (subject 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 IN2ERMENTS OR CREMATIONS
ARE MADE
Date of : .^•rr ` was t c 6 19 /
(Interment or Cremation)
1 (Name o Cemetery, Crematorium, etc.) "S
'\-)G W
Section c Lot No. 3 Grave No.
(Signed)
((W/r4/Pe on in charge)
Address
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 DIRECTOF, 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 OFFt.NSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.