Parker, Ira Form vs.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIEICA
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Tc. Registered No.._..`> ....._.
Vilhage- �,,y'�`- _
Dist. No �' County.. �' G--*`—��y----'� or City L-• i�—�� ...(If ety, g1eet address)
Name of ceased"..:�:<al� /'�'"`� �'� Veteran
> Single, married, widowed, (If Bran, give name of War)
Sex Color LCJ or divorced (wnte the word) •,-2-i'` --L--~^1Lzdte of Death.. al & 19 3
Age Years Months ..........pays ) Birthplace {
Cause of Death.. �- ? , ••• cz ‘-e..--C-z.-A.`�.
Certificate was signed by... f-, • M.D.
Address ,.,L—erf—x.-"-- . ..sL—•
Place of Burial (or Removal) - 7, ti -'-rz, •• ••••
(If body is to be tempora y ld,ell In apace lat r) /'
Cemetery —r..,,,::..�-- --2, ,,, . .,. . -7-, Date of Burial...6---(-A-'t ,- _ 19 . -'
(If body is to be temporarily held,fill In-apace later} -
ThG Certificate of Death containing the above stated particulars, having been presented e, 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 ' h the above stated R istereed
Number, n the basis there° I H R, BY GRAN A PERMIT / C�-T� /�
.( (Nf" �f�ddrese) ��
the ~'�� ._'`. to hold temporarily d ^ �Ti�,. the bo21
(II�ee''rtaker or peril° h n charge gg��c rpee) In ,r m ve, r otherw a dispose f Wats bow )
Dated....L.. ..r-__a_ ;. .,,/ 19,,,.(G,° (Signed) 'i, .� {A,.) L
Registrar
This Permits ufficient for the Removal (and Interment ar 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 SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date o f q 6 19
. (Interment o(-7-2r Cremation
7.
-----.7-_
_.._. .
ti),&'.* yr
. , .. _ ........,._, _.....,_3._...,_:,..
(Name of Cemetery, Cremetoeium, te.)
n-
A.
Section ``-- Lot No. ( j ) Grave No.
(Signed) ' 441, ate t/& /L '(
( rson in c5large)
Address 4_!:e04'. �iG y..� -- $�
Person in charge st return his ermit to
the Registrar of his District within S N (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 FOR THE FIRST OkT NSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.