Hale, Bernadette Term VS.Si NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
far This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
tillage, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF-}CATE OF
)EATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._...,../`..._ ....._
Village
)ist. No...329.4...County ONEIDA or City MARCY (If city, give street address)
Jame of deceased HALE, BERNARDET 7 Veteran l'Q
Single, married, widowed, (If ""'°' give name of War)
>ex..fema1e..Color...whii.e...or divorced (wnte the word)...kl).c Qw.cd Date of Death '_ • 4 . 19 44
age ci Y Months r...Days Birthplace... k t da.
:ause of Death 7 �w - 0.t•t _ '� t . 4a'�'[.t:L.( �� r 444Ar.ot"•
:ertificate was signed by 4�-.-, �.�.., M.D.
Address XL , /r ' 7
'lace of Burial (or Removal) 1
If body is to be temporarily held,fill in space later) !
"emetery Date of Burial ��7 196.2—.
If body is to be temporarily held,fill 1n space later)
Che Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
iation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
'umber, and on the basis thereof I HEREBY GRANT A PERMIT
Pga ) 4/address
he C..:S� >!4r(,-' ct-G9 to hold temporaril d .,1 `.. . . the body.
(tindertakg� or person having charge of corpse) (Inter,remov or of rwi s sew how])
)ated ;.fr-.,l 19�Z� .. (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
emetery 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 INTERMENTS OR CREMATIONS
ARE MADE
' -
Date of >r0-)--Y was r- 7 / '($>
(Interment or Cremation)
Mame f Cemetery, Crematorium, etc.)
a -ii- - .4
Section r-1 Lot No. .Grave No.
ti,^. 1 .. ^v.✓t. ,
(Signed) ` +(L ,�G--�
� (Person in charge)
7 ww�_
t-'
Address x" t 6 0 Q
t .. , >1- *..
Person in charge moist 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.