Murray, Elizabeth Form vs.EL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
to Tide 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—_.....5`-:w'
... Village . e,
Dist. No.:<..4..{ ..Cohn .. '.�..� � or City % -
��,,?? �. (If city, give street address)
Name of deceased e.2 �.tr.:(. Veteran `-2-
Ingle, married, widowed (If v an. give name of War)
�j ,
Sex 1 Color.... or divorced (write the word).../ . Date of De .. . . .... 4.: .... ...19 3
Age � YeaMonths Da s Birthplace.... V
Cause of Death L.. :r.G : :
Certificate was signed by - 4 .4�... 4 ,.z,cz...r M.D.
Address „/.. fcf:v.....r44'r. -' "7• ••
it /
Place of Burial (pr Removal) 4?.?.2.3 ...,'�4•y s .. -7Z�
(If body is to be to arily�e I space I ter) ) j
Cemetery �h..:' ; •" y.?�- ate of Burin] C.2rrr 19
(If body is to be temporarily h ,fill in space later) i
ThS Certificate of Death containing the above stated particulars, having been present' d to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have a pted the same for registration, have recorded it in my Local Record with the above stated Registered
Number on the basis/thereof I HERY GRANT A PERMIT
to r4:1a.r ci-? 1`� :�72-Z�.- ``V4-(, r .,.
/ (Address)
the L� ..2k.F '77 7 �s 4< � to hold temporarily and, -,1 the body.
(Und I ker or person having charge of corpse) (Inter,remove,or other 9 i'ose of [state bow])
Dated ►- --kJ. : ,. 19 C .) (Signed) Local
This -ermit 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 SJX1UN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of ^ T- a=f was 0 19 6 j
(Interment or Cre ion)
)gW . IN--L..4..0
y (Name Cemetery, Crematorium, etc.)
Section Lot No. Gr a No.
(Sided) it
4, ,/ ,_ t_ L. L- . , .Z,L(Per on in charge)
Address ,J : /, , b t,i
-, ,
C).!-: k- / 47e, '`.4.-'
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) DAYS L l~
. --
fran 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.