Bennett, Howard 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 Re istered No.
Dist. NS Count r.. _ ... ...... ..... or City -C- -L
(If city, give street a dre• )
:Name of deceased ... ... Veteran
(If veteran, give name of War)
Single, married, widowed, /
Sex. i- or divorced (write the word) Date of eath.. .. ' ,t../19.4.
4
Age Y Months.... . .. Days p Birthplace. ..
Cause of-Death
Certificate was sign d l..:�.r.�..l�..(� .. .--- ....,., . .. . .... ..... .. ' . .' ..,. 1VLD,
Address s�t1` �` e i, ? .
Place of Burial (or Remov 1)... - {
(If body is to be mp arily held, II in space 1at
Cemetery ., c-4 :�1.. ... .kt1 . ,..... , Date of Buri ..<,� a . 19.4..44
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been pr ented 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 Recor with the above ted gistered
Nu,. . , and on he basis reof I HER,BY GRANT A PERMIT � //
41,7„......_
II
t / ss
to hold temporarilyand •..• t body
ndert r or erg having charge of co se (Inter, remove, dispose of [state how )
Date .. ' -d, 19. (Signed) ,.. ta
L. Registrar
This Per is sufficient for the Removal (and Interment or Cremation) o o any part of the State (subject to local
ce etery or other regulations), unless removal is by common carrier, in which se a ransit Permit (VS No, 62) is required.
Form VS. 61. (Rev, 6/63) (3A2-333)
`ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
i
r
,"4
Date of wa 2— 19
(Interment or .ry taaion)
(Name of Cemetery, Crematorium,
1.. JJ
Section Lot No.' Grave No.1----
a
(Signed) _ —�/ — (
(Person in Charge)
Address 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.