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Guyett, Arthur Form VS.41. 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 CERTIFICATE OF DEATH. LEGIBLY WRITTEN INCJ DURABLE BLACK INK. f-T1 R„5 egist No�_.._...._....._._....._ Dist. No. 7.01..Coca ............. or City ' _ • (If cIty, gf6e street address Name of deceased Veteran 4,1 . 5 Single, married, w1dOWed, 4 (ff reran, Give name of War)41 Sex Color - ordivorced (wntetheword) / ate of D ...,�--.:. .... ....... 9.Age.... . Years:- > Months Day^ Birthplace ' Cause of Death :- .. .. �GZ.. '�`� Certificate was signed-by. /- _ � Address.... P• `)/ M.D. Place of Burial (or Removal). ' ..:?(If body is Cemetery.be^�temve-the and- later) Date Burial .r '' 19.W (If body is to be temporarily held,dii in space later) The 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 re 'stration, have recorded it in my Lo Re rd with the above stat d Registered Nu , and on the Dress 02 EBY GRANT A PERMIT,( . to.Lry / :....c 1 T ti ' o the DM to hold temporarily and.... t b dy. (U a ter or pomphaving charge corpse) J (Inter,em re,or otherwise Winos of[state bow]) Dated --�-c., / 19.. 2/ (Signed) - .,,_,." -L_t _ Local Regirtrar This Permit is sufficient for the Removal (and Interment or Cremation) of a y'to any part of the State (vrbject to local cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. ENDORSE/LENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE �-1 1� �19 Date o#' 2��«' was � ��l (Interment or Cremation) / 7efeHe.--2 f Ce , rematorium, etc.) Section Lot No. /15-lJ Grave No. (Sided) �,-' �11?i"_��-'.� -�- 7-�• /�� ( raon in charge) Address / s /47z 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 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.