Sinnott, Alice Th,rti yt'.ei. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
__ 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 CERTIFIC�Ste OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town R gistered No.__..-... '
..
�(�'' Village
Dist. No .577 County _ .(3Z1.1)L 1°� o v
i t� (If city, give street a res
Name de used..... .�-.i.C..E... �4 q.Q Pf , C P— ...tl er}/eteran(tf veteran, 1ve name of War),
in le, married, widowed,
Sex. e.1o1of� or divorced (wnte the word). .. Date of th .•.` .. .. ..IL ......19.l a9...
Age 15..2..... s . ... onths i Days �} .B•.is •lace Jo.
Cause of Death..... .. . . . .. .• . .... ......t..leS.nt....�...1..v. .'.. �t.�
Certificate was signed b . ` M.D.
Address
Place of to be .,.,(�or Removal) .. W ..
(If body is to be tem rarily held fill in spa a later) aa----,/
�„ A Date of Bur al.... 3Cemetery �J/��. 1 «.e...
(If body is to be t' emporarily held,fill 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 accepted the same for registration, have recorded it in my Local Record wit above stated Registered
Ninn and on the a ' thereof I HEREBY GRANT A PERMIT
to ..... .. :. v` . c—�'1
mil *decrees)
the _ to hold tempor and •. the body.
( n *make or n having char of corpse) i ZO
(Inter,remov e- Isoose of [state how]) n
rhoeye �„ �,(//
Dated jQ... ..., .G... 19 Z_ (Signed)
al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a y to any part of the State (subject to local
cemetery or other regulations), unless removed 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 o .Y r was ./; g(- 19 ep �--
(Interment or
(Name of Cemetery, Crematorium,- etc.
)
C-)1K4�*et0F Section Lot No. Grave No.
(Si wed)
(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 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 OFH.NSE.
The law will be enforced. Local Registrars are re—
quired, under penalty, to report violations thereof.