Frasier, Madge Form V&el. 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 _�.CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.__.. P—
Village
Dist. No..329Y County.....Qfp , or City Plarcy
(If city, give street address)
Name of deceased Madge Steuart Frasier Veteran n°
Single, married, widowed, (If veteran, give name of War)
Se P >oale Color white or divorced (wnte the word) uidoued Date of Death...Q _ 7 l 4 -4•ht19.lr..).
Age Years Months Days Birthplace Nleiv.York.•State .-r;
Cause of Death .&'-'t` (ems, _-, —_.f- , ,i% ,r' 1-
(_. -�, `,* -7 ':z,
Certificate was signed by .4, M.D.
Address '-
Place of Burial (or Removal) v(If body 1s to be temporarily held, fill in space later) II:-. / `
Cemetery Date of Burial ' ! [ 19.
(If body is to be temporarily held, till 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
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to
(Name) (Address)
the to hold temporarily d the body.
(Undertaker or person having charge of corpse) (Inter,remove,or,_o_f frwi;nose of[state how])
Dated 19 (Signed) i�44: :4 ' .
Pe . Local R
This Permit is sufficient for the Remove] (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regulations),unless remorse?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 �`L ,f was t__ _ 7 19_'-3
(Interment or- )
Win-- ��.f,>
`� / (Name of Cemetery, Crematorium, etc.)
Section 3 t-, Lot No/ / Grave Nolte A
(Signed) (� 7------ li/c,-4 7. a . '
(Person in charge)
Address ./ ( / / c'. a.2_.''"1--- _C Sic.._
Person in charge Heist 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 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.