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Morgan, Frank - NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT rar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town, Vilrage, 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, Village Registered No. 6 Dist. No..,..5 C."l . County or City (If city, give street address) Name of deceased ... .. frriel...., Veteran(If C (If veteran, give name of War) Single, married, widowed, or divorced (write the word) Date of Death ... .. 1 7 l9? Age Years() •Months Days , Birthplace Cause of Death 5 .liKf.. i Certificate was signed by - ... ./ M.D. Address • V •, .y• Place of Bur' or Removal r �/ (If body is to e emporari eld, i in ce ater) , Cemetery ...(. � ....... Date of Burial — i9 �j (If body is tote temporarily held, fill in space later) The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,the same ap aring to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra- tion, ha recorded it in my Local Recor •ith the ab ve stated Regist d Number, and on the basis thereof I HEREBY GRANT A PERM' a e) t • 4�ress the to hold temporarily and the body (Undertaker or erson avn charge of �r se) (In , remove, or otherwise dispose of (state how)) Dated � 19 /C (Signed) cal ig This Permit is sufficient for the Removal (and Interment or Cremation)of a body to Ziet th 4 ct to local cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permr (VS No. 62) is require FORM VS. 61. (REV. 6/63) (A2-248) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE //2 Date ,4j/Le-ki was r19/‘ (Interment or ) (Name of Cemgiterry, Cre Section _ ` _ Lot No. Grave I� /f (Si ed) (Person in Charge) je- --7z > / • Address 1 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 UNDER- TAKER MUST SIGN ABOVE STATEMENT, 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 required, under penalty, to report violations thereof. Form VS-67 (rev. 11/65) NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY In completing this form, please typewrite, hand-print or write legibly all entries in permanent black or blue black ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN" in applicable spaces. I hereby request permission to disinter the dead body of: Name of Deceased N,� Es Male Age(yrs.) ERA&k S. M4'Ie6.01a ❑ Female 7 4 Place of Death (indicate whether city, village or town) Date of Death Cause of Death G/ Ns Fel//s C; t Cemetery now interred gocation(city,town or county) Is hody to be transported by common carrier? f'r✓EViEW Rc ECi f'ut'/q dooa/t (2u EENcbwey ❑ yes Pa No State fully the final d fo ispositiox be made of bo y. 1 4/4,e M E/v f i N FF➢vre 4 5/ /D L Name of place or cemetery for final disposition Date of final disposition Firm Name Reg. No. Address )2140 Su/i ,,t<p 10. n 4.2 J 7 4 7 PA4Q Sf, F.�1I� ,v y. ;Signature of 1'u I ector or Undertake Reg. No. Date INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER: 1. See Section 13.1 (formerly Chapter XIII, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies by common carriers, as printed on the back of the Transit Label. 2. The data required concerning the decedent may be obtained from the local register or cemetery record. INSTRUCTIONS TO LOCAL REGISTRAR: 1. For bodies to be transported by common carrier, fill out Transit Permit. 2. For bodies not to be transported by common carrier, fill out ordinary Officjal Burial(or Removal) Permit. 3. In each case write the word "DISINTERMENT" on the Permit. 4. This form should be filed and carefully preserved in your office.