LeDoux, Moses tin vs.SL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 CERTIFICA37 OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No—J.1,?.. .
3294 Oneida Village
Dist. No County Marcy or City
(If city, give street address)
Name of deceased Moses LeDoux Veteran yes
Single, married, widowed, (If veteran, lve name of War)
Sex e....Color white or divorced (write the word) sflple Date of Death r ' b' 19 6Z
Age i Years Months D s Birth lace.GllanJs...k'a1.3,s.,...N. .York
Cause of Death �" .. -1r 1r.( 7 ) L4,t..,
Certificate was signed by ^�'�-- 5?� ___ 'j`' . D•
Address �� '
Place of Burial (or Removal)... `' t .�
(If body is to be tese�erarily held,fills apace later)
Cemetery / U.:tt•!.t.. (�' ., Date of Burial - 2-1 19 G L
(If body Is to be temporarily hel fill in space later)
Tha Certificate of Death containing the above stated particulars, having been pre ented 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 stated Registered
Number and n the basis hereof I HEREBY GRANT A PERMITG fgy/ i
to . .. , ry "''`�� ., ....._... z F'',�'t! 1x
Name
the to hold temporari y id . . the body.
(Uncle ker or person having charge of corpse) (Inter,remove,fir o se d s [state how])
Dated ..i�.y7 19..4.L.r (Signed) :Er..:t` �!•_ f
Dep. al R
This ermit is sufficient for the Removal (and Interment or emotion) of a body to any peat of the State (subject to local
cemetery or other regulations), unless removal Is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSE ENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTS OR CREMATIONS
ARE MADE
Date of r� was�� rti.t Z 9 19��
(Interment or Cre ion)
(Name of eterf, Crematorium, etc.)
} ed6„,„
0;4 .
Section Lot No. C/ Grave No.
fitt,4"-e7/7..(1) ,,C,L6g2.4 —
/(Person(Person in charge)
Address OP Q ' Q674- Co 0-0
Person in charge must return thi 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 T1E FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.
•