Cohen, Marcia Form VS.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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.__.._...._............
Village
Dist. No 198 County Albany or City 113 Holland Ayenue„ Albany, New YgX.R....
Marcia L. Cohen (If city, give street
to 6/3/63
Name of deceased Veteran
Single, married, widowed, (►t veteran, give name of War)
sex FemaleColor White or divorced (write the word) single Date of Death April 11 19...6.4
Age 31 Years Months Days Birthplace New York
Cause of Death Infarction of lungs
Certificate was signed by Crari.o R. Zumbo M.D.
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Address YA••H°§ i.ens'Fa•lls�$Liew"YoxX•k
Place of Burial (or Removal)
(If body Is to be temporarily held, fill in space later)
Cemetery .Sh.aar.ay...Tephilah Date of Burial April 13 19 64
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to Levine Memorigl Clap.Cbap.0 2.30..Be,l,aware..Ave"...A1bany,.._New..York.
undertake') (Address nter
the to hold temporarily an• ))t �3 the body
(Undertaker or person_baring charge of corpse) / rr,rem",or otllenvlse s�ose of to
Dated ,1.2r 19..rc./.. (Signed) Local Registrar 1„4„40`- a
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of � 1 ', was (` _ • / 19 4
(Interment)or Crematlo$) 1
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� ��'<.A. '\ �'�1:� .i (`,. .:e.
(Name'of CemeYeri., ;rematorlum, etc.)
Section Lit No. Grave No.
(Signed) `�: ft. ..
(Person in charge)
Address : ,.' �,`;�,�.r• 4,�, \ i' t, �Jt...( 4L. ' '
Person in charge mush return this Permit to
the Registrar of his DistN ct•within SEVEN (7) DAYS
from above date. If no person is in charge, the
FUNERAL qjDIRECTOR or UNDER ER MUST SIGN ABOVE' STATE-
MENT, write across the taco of tne PerT t the words
•
4`'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.