Winkel, Marion Form VS.el. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Dr 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 ..-
. ., , Village ,,
, ./.7.( '-7
Dist. No" ' 1 County........ ..4i-aa..-0...-1,... or City -./-d.../a„,g -a. „...e.4.--
,
(If city, give street address)
Name of deceased....I' 114-7-2-(4/ ../L-- /./- .--ei Veteran
, / (If vil iv mune of War)
Sea
bk- Single, mared, widowed,....../ -- Color. .r or divorced (wnteth e word) -----2-2-7--'4'1Date of .,,ii
, ._
Age 6,,, S. Years ) Months .-. ays , ,Ilk:thplace
-•/
Cause of Death......e.f...a.,i1 ‘-,=---k.: i .i 4. 7-ex-k-e-fer.---4 ,'
Certificate was was signed by. ,e-c-4--(. ..0..a...---.ZA-.Z. t.-al. :1-/ M.D.
Address . .-i,,,r4.4j.74,--,--:;e:_2-2
- ._e4,' /9'
Place of Burial (or Removal). ..r ,O.e.--0
(If body Is to be temp,pyily)seldeil in;Pace later) •
Cemetery ..0 :-:".V (-Cc. .. ..1-:".--kh‘.Z.Z.,.:. ''..:'..e...e4.<.--:1r2 -
Date of Burial
a."- --2--1 ' - 3 19 f-
(If body Is to be temporarily bel ,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 acce ted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, ,the basis thereV7HEREBy GRANT A PERMIT /
, Ze.
tO • a.-..7.--,. .Y. c.:4:t..4?--- a--:::,.. .2 _ t7Z-EL
.,V
the -.4-"C‘Ce,fict--Z. .c to hold temporarily ariso- t-,-a----- (Address)
the body.
(Und ..?x.2. r.:prippa haying charge of corpse) ..izr (Inter,re ye,or olo seI TT of(state bow])
Dated / '?,- 2,- 19 (Signed)
Aegistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body t ny part of the (srabject 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 CREMATIONS
ARE MADE
Date o was �J 19` -3
(Interment or CremVA,.
J (Name P Cemetery, Crematorium, etc.)
j pp G Section Lot No. ✓ e
(Signeao, /. 22, 9I��.��P �.( . ff
.(Person in arge) / )
Address 0, /41../ 6 0 0
?
Person in charge must return this P it 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 FUR THE FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.