Silverman, Ester Farm vs.!IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
d' 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 CERTIF C TE OF
DEATH, LEGIBLY WRITTEN IN DU LE BLACK INK Town Registered No—. ._ ._._
���� Village
Dist. No �- /`*"County........... �.W or City
(If ct give street add'
Name of deceased 6„,e- 4 ..ice e -1 eteran
- Single, married, widowed, Of veteran, give name of War)
Sex .Color -i' or divorced (wnte the word). -L.140 ee Date of Death -/‘. 96
Age 7/ Years.. , Mon s ays B' place '—
Cause of Death l%t.� �w: .�.... lr� e a�� �xr�!u:.. a a.-T.`1
Certificate was signed by ;(::"Z'
M.D.
Address :. . ... ... :�f —4�
��''jj
eiy
Place of Burial (or Removal)....��i~ rX. v . .
(If body is to b tempora y held, 1 in space ater) /�i `3
Cemeteryy7�in Date of Burial �/ 1
(If body is be temporarily be d,811 in apace 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 theEeof I HEREly GRANT A PERMIT �// ,�J
to. .t;.4- 4-0,:a"w-.x:a.... P. ./.,?.',A-z-e 4- e-t. ...... tt r� �.�:d. ..._.>0.. `,,
//�� (R ) Address) /
the LZ. f-----' to hold temporarily and «..: .Ad the body.
(Undertaker or person having charge of corpse) (Int ruoye,or of rwise dispose of[state how])
Dated - /2 19.... ..--7 (Signed) 0.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) a body to any pert of the Slate (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 SEITON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTEBMMENTS OR CREMATIONS
ARE MADE
Date of was ic• " )r 19
(Interment or Cremation)
(Fame of Ce+ try, Crematorium, etc.)
Section Lot No. Grave No.
°41
(Signed) lJ-
01
(Pereon in charge)
Address 11 °)U d dL ,l 120-4.,(V 100
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 OFFhNSE.
The law will be enforced. Local Registrars are re—
quired, under penalty, to report violations thereof.