Craig Sr., Herbert Form vs.4IL 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 CERTIFAcAl'E.,
DEATH, LEGIBLY WRITTEN IN V
DU LE BLACK INK. Town
..,.. Registered No.4 . ..
....7AB
Dist. Noku.I.Z.e.,e..County...-. . .... ...eg-dr.o.x.o.s.., or City
(If ety, give street add] 1%,
,
deceased.c..... .. ,,ee' -- I./ , Veteran
Nam of
(If vet an, give name of War)
i_Agngle, married, widowed, i
S a. . 4e.Color.i.. divorced (write the word) .. . Date Q,14101eath • ce' 19.. -
Age. 7- 1. Years Months Day Birthp ace.47.0 •
Cause of Death... . .
Certificate was signed by.... .... ,.. ' M.D.
Place of Burial or Removal) ,, t—ree:Ta<
(If body is to 1:7s-tf ril in aii,held,fill in ,,c,I,ter) ,_,..-
Cemetery.. ..—.1.....o14,,,,....••• ••• • ,,,d7,—.1.---0-7-7.... . Date of B al a3 ' 4P---. 19. 4--0'..7
(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 hay. accepted the same for registration, hav recorded it in my Local Record with the above s ted istered
Nu il , and on e basis f I HER G NT A PERMIT
91,4
di to hold temporaril and t:.: ?"12.=9 --) the body.
(tin kerpr person having charge o.j‘cge) (Signed) (Inter o,rem ,or otiistrarse dispose of(state bowl)
Dated e,....7.
tteai R
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (enbject 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
G �Date of � 7/: waspc/ 2--- 19 r"�
(Interment or Cremation)
', 4,/....kl_C— 74/7-7•..... _,,e:72 Z(
(Name of Ceme ery,`, rematorium, etc.)
4,
Section Lot No:---/7A Grave No.
(Signed) ?r,...."‹.)-e ----: . "_c 2.-(C�*
(Person in charge)
Address G!' Aj/_..
L < ,-' �
il / . 7.._ *
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.