King, Edna vs 61 NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar This Permit can be signed only by the Local Registrar (Deputy or subregistrer) 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.__.._.:..-.
n I. Village `� "
Dist. Nos ..�1.Coupty.L..L..: .'.�� . .:. `— or Cliff l..c..1:..Gt 11(
////// / ' (If city, give st/eet address)
Name of deceased..4r. .4.44.i/ .(G Veteran /
�y,�Single, married,"widowed, (If v reran, rive name of War)
S .•Color.ttcld"eG..or divorced (wnte the word)..lft,it'1 .......Date of Death.l. .. . .... . ..1�
Age V, - Y rs.. _ M nths. Days Birthplace
Cause of Death-.
Certificate was s rn by r.: ►... .. M.D.
Address ..
Place of Bun)! (or Removal) � , .. a-t�
Ay
(If body Is to be emporaril held,fill in space j� ) j /7----
Cemetery:/►;- �:.e. :• .(..cs, +•:• / Date of Burial. . :01 ,..i....CRR-( 19 '
(If body is to be temporarily 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 have accepted the same for registration, have recorded it in my Local Record wit• the above stated Registered
Number, and on the Asia thereof I HEREBY GRANT A PERMIT
' -61-1
to ..aT--Se. .. (,
(Name) /Atlas)
theS41,. ����� - s.4.:-.4.4.A' to hold temporarily and the body.
ertak r or person ba' ng chargg of corpse) / (Inter, r otherwise/ a-6 [sta ,
Dated` .•i( i9(v.?> (Signed). e..C.ek see •
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pert 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.
ENDORSEMENT OF SEX'IUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date ' 'v""'--.- ( .2` 19 — d4
--) (Interment or Crew ion
j
i „_____1, __f_____,„
i
(Kane of Cemetery, Crematorium, etc.)
Section Lot Grave No. /
:7
(Signed) ` ' --- , Gi� '
(Person In charge)
Address G' 7'(#
r ' — .----" ,' '
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 OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.