James, Leonard Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 No.__..,3bi`f _
Village c �
.�....I..Coun . - .� �'Y. ?:a.e,.... or City 1 �.et4r
,�}� (If cet glue street address)
Name of deceased.: ... Veteran -�-
),- Single, married, widowed • (ff veteran, give name of War)
Sex.., ' Color ,,C or divorced (write the word -/-4- Date o Death . . 19..��:3
Age Years. .Months .Z..-..Days Birthplace..£/L�Lt/ .•••
Cause of Death: . v.-1...�...
Certificate was signed by M.D.
Address q ,;..- 4 ,•
Place of Burial Removal) ,l.. t ....
(If body is to be arily held,fill space later) /'-)
Cemetery ✓.!-M.L, J (G:L''" 4— "i ' Date of Burial £2-t- .�r- / U 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 ac pted the same for registration, have recorded it in my Local Record with the above stated Registered .
Numberd/,0 the basis I HEREBY =I; A PERMIT i /
��jj J (Address)
the '. � . .. ..... ..e to hold temporari and... tthe body.
(Under er r person having charge,of corpse) (l.nte,K,retmovenor otherwise diIoose of jsste how])
Dated .J.0 19�r- (Signed)
Signed) V� "�,11,) t OItk
Loc Registria
This Permit i sufficient for the Removal (and Interment or Cremation) of a body to any\'part of the State ( ject 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
y
Date o w :' a.�/L! 1943
(Interment or Cremation);-
(
(Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.7211.
(Signed) . . ›,j/16:,,,,,,?4/7,:.
(Person in charge)
Address G lC i t( ce,i ,-.41:
,P;-/-,..„_.
,-ia'; -5 . .
- ,
tito Person in charge must return this Permi
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 FOR THE FIRST OFFENSE.
The law will be enforced. Local Registrars are re—
quired, under penalty, to report violations thereof.