Dean, Mabel Form vs.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or This Permit can be signed only by the Local Registrar (Deputy or aubregistrar) 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 IN DURABLE BLACK INK. Town Registered No—_.: /4'..._
Village
Dist. No 3294 County E EIDL or City
(If city, give street address)
Name of deceased Mabel Et Dean Veteran yeS
(►f veteran, ve name of Wu) -
Single, married, widowed, `4, y 6
Sex femal@Color whiff nor divorced (write the word) single Date of Death �" 19 ` "
Age '�- Years., Months „...Days Birthplace
Cause of Death GL y c 1,,.- 'I c--�e.r� Jam. ht_4- 14 ,C>-' 'y:. k� :-1.1.-:k c ; _ . r.�i- ^,-4..1--
Certificate was signed by (` , C `.'4.'t.""• /t-t 0 4. Z_aw c-• I M.D.
Address
Place of Bu 'al (or Removal
(If body is t temporarily held, n sp
,/'Z Cemetery . ' ((( -�?� • 4..ui /L, ) ..ate of Burial.. . . e7 t. 1.J 7 1(96Z
(If body Is to be temporarily held, fill in space Late) r I
The Certificate of Death containing t'he above stated'particulars, aving been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have fAcepted the fo gistration, have recorded it in my Local Record with the bov ist
Numbe>q,f arad on tf is' f I HEREBY GRANT A PERMITii/
to 11LL J ft� c.� ,
(Name) (Address) the body.
the to hold temporaril a d Y
(> er r ving charge of corpse) (Inter,remove,,r otitise di of[state how])
Dated • . 19 (Signed) -..-..*r--
Local R
This Permit is sufficient for the Removal (and Interment or Cremation) o a �y to any part of the 'fate (subject to local
cemetery or other regulations), unless removal is by common carrier, in which caa fa Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SJiX1UN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date o " 47' 19
(Interment o • )
(As or Cemetery, Crematorium, e4.)
Section Lot No. Grave No.
(signed) /L
(person In charge)
Address -'$c�- 'z---
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 1,ardc
"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.