Suckman, Isadore NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
- 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 CER-
TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village ,� Registered No.... �fe.........
Dist. No. 6/ Cot nty....... �/�fr� ��- or City y*m ' � ^'...
p (If city, give street address)
Name of deceased )-e-- -1 2 ,r Veteran --
(If veteran, give name of War)
Single, married, widowed, '
Sex or divorced (write the word)M7 Date of Dotj} Cf/'l 7 19.4: `f.
Age & Y rs. Month Days Birthplace..,5 1.t ....t "e�J�� 11.7•
Cause of-Death._..L c - ' s-11--2-1'-r'•�a7--<-,7
Certificate was signed by ,:. M.D.
Address .• "- 'I
' ,--' ... � �22 z
Place of Burial (or Removal)...._. -4 ;:?L.‘ < .....:..... . .
(If body is to be�t I „,;r arily held, fill i cq ter)
Cemetery c t;,...C4 -2 • Date of Burial 6 / 19.�j
(If body is to be temporarily h fill in s ce later)
The Certificate of 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
Numbet2 on the basiA9 th eof I ,HEREBY GRANT A PERMIT
the �� (N ne) (Address)
to hold temporarily and the body
(Undertaker or person having charge of coarse (Int r move, or otherwise ' pose of [state ))
Dated .0 '.,../..1- 19 .. (Signed)
Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ( ubject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No, 62) is required.
Form VS. 61. (Rev, 6/63) (3A2.323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date of JALtilk-A"..t.t._was Vet l 8 19 .
(Interment or Cremation)
ame of C etery,.Crematorium, etc.),
v
Section____— Lot No. Grave No._—_
(Signed) ._ _c)1444' JJ
(Person in Charge)
Address h h ` V _t /& � 4
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 UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and FILE
PERMIT WITFiui1 THREE (3) DAYS with the Registrar of Dis-
trict 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 required, under penalty,
to report violations thereof.