Ronkanen, Vaino Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or This Permit can Is•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„,c7.3. ..............
, Village ,S a4
Dist. No 44 0/County..7i.K.A.7-re---17-/ or City „„.&-z4„-a.,/ -,, 4.--'Z' ---
(If city, give street address)
.
Name of deceased ra..„...,„4- . 4/ ,4a..,...7.,..,....._ Veteran
(If veteran, te name of War)
pi Single, married, widowed,
Sex 111. Color f r or divorced (wnte the word) ) 2 a-r-r:-J Date ofyfath , s/...i.A -,..../..g...194.3.
2
Age 4. 7 Yevs. Months Days / Birthplace 41--e--iti7.4.44 ih
Cause of Death L.t.c.d, .. ,--f. .... _Q-et.¢.-,..i."423,_,
Certificate was signed by Q....4...._...*- , M.D.
/.." .
Address IV- >7 ,
Place of Burialemova ) / .4 a. ....-(....4A-c-'1--'-a --6z-V '..)7 r
t
(If body is to be te po ly held,fill 19..ftpece Itter) i
Cemetery .etevNie l'ef--'4-e'r. C."X-21-4, Date of Burial k/.-I'C-- )- e) 19
(If body is to be temporarily held,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 accepted the same for registration, have recorded it in my Local Record with the above stated Registered
to
Num. Aihand on the basisyti.
1 vof I HEI7 GRANT A PERMIT..]-44 :-.10. -
40v (N (Address) .
the Vtl!l74 " .------' to hold temporaril and the body.
(Undertakerson harmeharge of corpse) (Inter,remov or arise drss of(state how])
Dated ---e-‘,,--' - / 19..e:. 3 (Signed) -<-1-2---1-"\-....._
Lkcal Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (soubject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSE ENT OF SEXTON OR PE RJN IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date q was; 19,�4
(Interment or Cremation)
(Name of Cemetery, Crematorium, etc.) l'
e&N(jidi79
Section Lot No. / / Grave No._}
(Person in charge)
•
Address �' ��(. .._. �-- ' - '' r
, �
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 cords
"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.