Irish, Francis NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ISF' 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, LEGI L WRITTEN IN DURABLE BLACK INK.
istered No 7
Town, Villages .
Dist. No. . 517Count ...- 0.lC1.1N-.\ of-Citys
(If city, give street ddr s)
Na le of deceased -..LtZ. �'._/_5 , IL.1.51`f .. Veteran
Single, married, widowed, (If veteran, ive name of War)
Sex_.. _..._. or divorced (write the word) - DateDeath //. -...7 -4
Age ‘ s_... onths._.. Days ABirthp ei 1'v-
...
Cause of-Death --. .- . _
Certificate was signed by__ 9...".. M.D„
Address_. i 5 -.. J
Place of B or Removal.,._.
-
(If body is to .- .orarily heldtt fIl�in space later)
Cemetery • �",-€_-_4 .A.& L Date of Burial Ai 9 19 . -(If body is to be temporarily held, fill In space later)
The Certificate of Death containing the above stated particulars, having been presented to e, after careful exami-
nation,,the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have acce.:ted the same or registration, have recorded it in my Local Record with the bove stated Re ist red
.er, an; poi , --ibasilt reof I H EBYfiGRANT A PER
. , 1-- ' t .- troatc3 7e 4 I ,
the_ �` dress)
IV to hold temporaril n the body
( de a ker person having charge of creme) (Inter,remove, or wise isp a of [state how])
Dated J/ 9 1 - . (Signed) .,, t�n..e
ilegistrar
This Permit is sufficient for the Remova (and Interment or Crem ion) of a b d r to any part of the State (subject o 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 CAR
CREMATIONS ARE MADE
cLy__
7) _
Date o _was— 19
(lnterme )
__Zi .. k ,
( ame of emetery, Crematorium, etc.)
Sect'i Lot Noj77 Grave No._I—_
(Signed) - 14 t. �'' ifiAl' �d/L� Ea
?#-
(Person in Charge)
Address 6:____r?--712fr---4-- • 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 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.