Yafee, Bernard 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.__.861
Dist. No_ .__,.4102 County Renss. or City Troy, N.Y.
(If city, give street address)
Name of deceased Bern rd Yafee Veteran
(If veteran, give name of War)
Single, married, widowed,
Sex 1w'ale or divorced (write the word) Date of Death Sept• 2$ 19 b5
Age 85 Years. (I Months 22 Days Birthplace Poland
Cause of-Death Circulatory — c llapse
Certificate was signed by Dr. Wm. K. Griesau M.D.
Address _ _, - 2109 — 15th St., Troy, N.Y.
Place of Burial (or Removal) W.Glens Falls) N.Y.
(If body is to be temporarily held fill in space later
Cemetery Shaaray Tef later) Ca, Date of Burial Sept. 29 19 65
(If body is to be temporarily held, fill to 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 Tho �s--G,--,Blinal3an lens..Fa l l s.2...R.Y...
the Undeittitbr to hold temporaril a d Inter. (Address)
the bod
(Undertaker or person having charge of corpse) (Inter, remove or rwise J!/4f�a�/bf�e ow))
Dated. Seats 29 19 6 (Signed) �j
Local Regist ar
This Permit is sufficient for the Removal (and Interment or C mation) 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.
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 was 2 47 19 (0.
(Interment or Cremation)
..2aa,..�a�'gq�J--
• 64-4
([�4me of Cemete , Crematorium, etc.)
Section_• Lot No. Grave No._______
(Signe
(Person in Charge)
Address
Person in charge must return this Permi o 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 Di
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
rill be enforced. Local Registrars are required, under penalty,
a report violations thereof.