Steves, Earl 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.
Registered No. -2/ 7/
Town, Village
Dist. No -County ,ii.,, 111.1117-,..,,,,?.--1.-"---- or City / ' 11-'
(If city, give streeti ,avdedtreersasn),
Name of deceased C°0(-ra „2-b<12-tA Veteran
(
give name of War)
/,.. Single, married, widowed, , . ....-
C,,, or divorced (write the word). .{..,. .-,- " C D e of D 2 -/D 19(:,--5
Age Years Months -Days 4 B. plac
Cause of-Death 4._.,.... , ,
.(1..../t4... 1-•••-_ • Cf a r-.jPfr i'
Certificate was signed by: 114. . 41.0 04',eawitei7 ,., . C.-. M.D.
Address Mira"
- ,
Place of Burial (or Removal) ° 4, ' a..•..e. .
(If body is to be temperpily held, fill iS-space I ) , / i ‘ '
Cemetery I.`, ( . I ,I .,, , c4-8 '--° Date of Burrial af-/-1.1„et If 19 —
(If body is to be temporarily held, fill in space la er) AV
The Certificate of Death :gaining ,1 e above ted pticulars, having been presented to me, after careful exami-
nation,.the same ap.,-.ring t,, be r II PL , C RECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted t. same fo re tratio ,'have ecorded it in my Local Record with the above stated Registered
Number, and on the basiis th. es I EB GRANT A PERMIT iz.. .._.
y(Nte-4;. 1.---.:2!---'
the. ... .. . . ..:44.-i..„
.v2,,,,,.xzei
,, ,(Address)
to hold temporarily an ...7...4 ,X.,..cs••_ the body
(Undertaker,o person having charge of corpse),... (tnt re/at vte, or tAbeAwise dispose of [state how])
Dated .. .. 2.,-1.31 19 (:.,..): (Signed)... ... .
Local Registrar
Registrar
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, 82) 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 o ,' / was 7L3-
(Interment or Crem ion)
(Name of Cemetery„Crematorium, etc.)
Section — T.ot No. Grave No._____
(Signed) 1��, r n _ y `—.�2 j 114zr,(Person in Charge)
Address / 7li� ✓` 6-Z.
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.