Zimmerman, Hyman Form vs.a. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._ 193
Village
Dist. No �+102 Count}, CityTroy„Renss. or City y„ N.Y.
(If city. give street address)
Name of deceased HTman Zimmerman Veteran
(li veteran, give name of War)
Single, married, widowed,
Sex IviA1e Color W or divorced (write the word) W Date of Death Feb.a..28 19..63.
Age 7$ Years Months Days Birthplace U.s.S..
Cause of Death Pulmonary...embolus
Certificate was signed by Dr.....Iruing..Stresherg M.D.
Address 7.1..Second..St.., ..Tsy.,..N.1.
Place of Burial (or Removal) Que.erts.bury,..1LY.
(If body is to be temporarily held,ell In space Deter)
Cemetery $b$a.r.Pi. TPPilil.A. em, Date of Burial March...1 19....663
(If body is to be temporarily held, fill in space later)
Tiff;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 Thomas G. Mi17,Ahar Gi.e.n .F4.113.,...N.Y•
Undertakfrme) Inter. (Address)
the to hold tempora and the body
.
y.
(Undertaker or person having charge of corpse) 1 (Inter, re ooYe)or ofh disoose of(state bo })
( ) i .. j s Loc Registrar
This Dated F.eb....28 19..63... Si ed , G .i/tet,/.Yt<:. ..,/)
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 SEXIUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTE1WMNTS OR CREMATIONS
ARE MADE
Date of was 1 ) 19 ItS
(Interment or Cremation)
(Name of Ceme ry, Crematorium, etc.)
Section Lot No. Grave No.
(Signed)
(Person in charge)
Address 1 / vMU JJL ,: .
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.