Harris, Mabel -sTe mi VS.el, NEW YORK STATE DEPARTMENT OF HEALTH / /
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fia. This Permit can be signed only by the Local Registrar (Deputy or subregistrax) 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 RITTEN IN DURABLE BLACK INK. Town
,,,-"ARAT - 'A Registered No.
S 06 viL...t.S.L. Fii.NGo N. Y
1 r,_-:•ri Village 'ID I le't
Dist. No ‘../
oun
" ' or i
or city, give ree es) 9
Nati00,,f dece d... . . *iv, /e/ila.-,12 1776J-7° Veteran
Av:.e, married, wido , ( veteran. give nam ef
r • . Oi .rAivorced (wnte the w .. . .. .... .. ate o .1*
Age 6-6P.Years , onths. , ../ .Days Birthplace... . ... .... . .. •-..... ..
Cause of Death 4;0 r 7
Certificate was signed by . M.D.
Address ..
..0,' .... or•., 1 dr
fir, 4, ..... '--217
Place of Bu *al ( r Re valiCW,,,A...0. " ail'," of .,
(If bo is tem rt. , fill in space later /J,, sogr Z.
x , 4of1
Cemetery . .... . Date of Burin .
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been sented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISF. -TORY AS REQUIRED BY LAW,
I have accepted the same for registration, have r- .rded it in my L./al Recor. with the a• •ve stated Registered
N mber .• • on '..e has . - •f I HEREBY " •,. NT A PERM
to . I d .. ,
4414/60004,../ ,., , AO ,e i:•_0::40 .468,,, - -.o
Alder.' ' / ,,le z le/71W
the , , 7 Am.,. ' .to hold temporarily .1- the ody.
(udiper or person hilk cbargqwpf corpse) '''' ,,,,A4Ititer, remove,or otherwise disnose of[stats bow])
Dated.:- , ' i ,, 194.4: (Signed) ' ,..... --.'4' '7 Local Registrar •
.11 ermit is sufficient for the Removal (and Interment or Cremation) of a body to any part of a ( • t ocei
cemete or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No .
ENDORSEMENT OF SEXOON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date was c 19
(Interment or
(Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
(Signed)jage
(Person 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 DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the wards
"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.