Lombardo Sr, Joseph ..i.. •vnn J loft 1G VG rfmn I m E n 1 Vr riciumi17
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ILA 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 CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. c
Regist red No. __. .
-___. / Tow , Village ,Z,6,1,c, _017 it,
Dist. No. 6 0/ County �' aA4(.,C'1'✓ or ty
If city, give street address) I
.
Name of deceased.__. , — Veteran
•
(If vetep ,give name of War)
�� Single,married,widowed, �y
Sex or divorced (write the word)J€ `' i G - Date o eath _'w� 19_�_�
7Age 7 Years Months ._ Days Birthplace _ -��
Cause of Death C�, . . J(� y 7 Ce---& -
Certificate was signed by .__ _Q_ __ .��__ • M.D.
Address AZ__.-7i./ h'7
Place of Burial (or Removal) t..-�..,Zz _. /
(If body is to be t porarily held, fill i .p a later)
Cemetery 4--G4.-ar-- Date of Burial ___ ___ C3 19 7�
(If body is to 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 appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LA , I have accepted the same
for regis ation, have recorded it in my Local Record w''th the above s ed Registered N ber, a d n the basis thereof p HERE-
BY G A �5}` �rt�Z ����
/J /
�� ame) ) (Address)
the _-.- --_ -- -- ek.„1f-- - ___¢� to hold temporarily and � � the body
(Unlertak or pers having charge of corpse) (Inter, ove, or otherwise dispose of (state how))
Dated .� 197:4 • (Signed) AA
alcal t t
This Permit is sufficient for the Removal (and Interment or Cremation) of a dy 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.
FORM VS. 61. (REV. 6/63) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of (Ar✓�-1-11,was 910 19
(Interment or )
(Name of Cemetery,
Section cX 9 Lot No. 7" ' Crrave No. /
(Signed) ���� �
(Person in Charge)
r-
Address / '
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 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 UNDER-
TAKERS violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOL-
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.