Zenger, Harold Form VS.sL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or ThI. 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 IN DURABLE BLACK INK. Town Registered No._- °
4102 Renss. Village
Dist. NoCounty or City Tm.y.,...N.LY-
(If efty, give street address)
Name of deceased Harold ► . Zenper Veteran
(If veteran, give name of War)
Single, married, widowed,
Sex X. Color..!1V or divorced (write the word)..14 Date of Death Feb. 21 19 62
Age 51. Years Months Days Birthplace Sc.m.ntan,...k',fr.
Cause of Death Qn.1 Qxlary...ac .1.>as.ian
Certificate was signed by AI'„ G,F.,...IiPed M.D.
Address 5$.,,SAcgncl St,.,
Place of Burial (or Removal) Werren Cauntyf N.Y.
(If body is to be temporarily held,till in space later;
Cemetery FMA iigN.Celit. Date of Burial Feb. 2g 1962
(If body is to be temporarily held, e i 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 registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to C...H.....Ada,son..d4...?.on...by...E..'.....}liio.e.r... :i'.roy,...N...Y'
TindertakerIName) ;'`�,, (Address)
the to hold temporarily a�ld ante tt�x.. the body.
(Undertakes or personhaving charge of corpse) Inter,remove,pro �rwlse ssy,o s to howj) /
Dated Feb.e 2 1962 (Signed) /.. -4 -e- 1 r % �f /��
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (rrbject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) u required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMI SES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
--‘.Y/7; irl-
Date o7;;7'--
was :--440( .2_C 19
--) (Intrsent o )
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.-'4 i' t '.-- (T_/---'2 t—7-------"1— C:---;.—4 1(4—1 '''' a,, /(,_-
(Nose of Cemetery, Crematorium, etc.)
/
Section Lot No. Grave No.
&l
(Signed /'''C iL ic-" l�)i , �,.--.
'(Person in charge)
Address Y %r�' C -'( 2 `t.,-l�, :( ,. _ . .. 1-
t\ 111_,__. .._, :..2 -,-- ---_-37
Person-in charge mus return this Permit e 1
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.