Fraser, James Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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, T-o Registered No. .. U....--.
Village
Dist. No County.........:s?�.in•, +on or€ity 29 C ole; ?n Avg
(If city, give street address)
Name of deceased....:11 ;S..uiciCEwu,.^..l rRf1.&EE Veteran ao.
Single, married, widowed, (If veteran, give name of War)
Sex...,..n Color ','''h to or divorced (wnte the word) 4,.Cai`ried Date of Death October 21_1 19 -
Age 'J5. Years 9 Months 2Q.......Days Birthplace..�G.Qt? nd
Cause of Death.....c.az:cinn ia..J anncreas
Certificate was signed by J.Qhrl. :.cCann. M.D.
Address - ,= ?e -uxeCt "11Q2.a13, r a7 i,s ''AY`
Place of Burial (or Removal)......TD mn..cit. .en.sbuey ":arran..C.Q.:.)'o.:T•
(If body is to be temporarily held,Oil in space later)
Cemetery X ...ni ri .3:Aglt Date of Buried....Oc tobe ..2" 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 with the above stated Registered
Number, and on the bash thereof I HEREBY GRANT A PERMIT
to,C.�,x:1o. QJ run.ex. Ii c TnQ...(n.:..,.+',T ,1 2.11)....._... 'jzL1S oX1 -'all2 N„v•
(Name) (Address)
the..naanerr D�z:Bc�.c�s° to hold temporarily and Inter the body.
.
(Undertaker or person having charge of corpse) nter,remove,o,r,of�a dispose s to ho
Date( .ct.t2aer...a7 19 (Signed) aiL—CL. I, R�..7
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part 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 SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CATIONS
ARE MADE
7')
Date ���i%Z _ 19 6 2_-
(Intersent or- ion)
(Name of Cemetery, Creme torium, etc.)
/ :2r
Section+ Lot No.� �� Grave No. 2_
(Signed) ��!<%@C "_�' 4 '!_� .
(Person in charge)
Address :O c e, 2! =e
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 chime," mad 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.