Krebs, Paul NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
aSE' 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 RITTEN IN DURABLE BLACK INK.
Registered No 7�-
7 Town, Village .
Dist. No. .(�i . .. Coun ... Gr4 or y- �.t.. .
(If city, give street dress)
Name of decea ed -c L,64/V(- Veteran
J (If veteran, give name of War)
D- Single, married, widowed, -
Sex d ,e&. or divorced (write the word)."/. . _ Date of D th...,J-i 7 19.44
Age 762arsYe months D ys Birthplace_ .. .. . . .,�i:. �Cause -Death.J.
Certificate was signed _. ., ... __,..__ 2 M.D.
Address 4F. ` ,1 -c- .,.... .. e--4-"-a.�/tea, e: ::c,.. 2•:--/-Place of Burial (or Remova ).., tL,C.,'i[� r -_ -
(If body is to be to por;rily held, 1 'n space ater �/
Cemetery.. . ..Q1..._ ._,<t'-L __ ____ Wit. . . i Date of Burial 1l 4) - 19L.�f
(If body is to temporarily held, fill in space later)
The Certificate of Death containing the above stated articulars, having been presented to me, after careful exami-
nation,,the same appearing to be COMPLETE, CORRECT, AND SATISFACI ORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above, stated Registered
Number, d on the ,b 's thereof I HERE ! GRANT A PERMIT�L ' ) / %// „le2,(4.,..
tte� , / ddrrea
the to hold temporarily and ✓✓ 4?
-- the body
(Undertaker or person having charge of corpse). � (Inter,remove, q wi dispose of [state )
Dated...)I.- i 9 19L (Signed) "J .&.mot -e tttttt
L al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of, body t 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, 8.) 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
, i
Date of �2' !>0 fwas41 ? 19 4.
(In erment or Cremation)
v (Name of Cemete y, Crematorium, etc.)
l3 a
Section '� T.oi No. Grave No. —
zy
(Signed) �,t- jLP A- �f!' f tit
77
(Person!'in s g )
i
Address ' "----- ' l' _.
i
i
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 WITHIN 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.