Norton, Claude 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 f�/� Registered No 36'
Dist. No.J .d../... County...44i�:I/cri!✓ or City / u7c""""f )1.
ty
.
(If city, give street add ss)
Name of deceased fle&sd ?7,0 -t_ Veteran
(If veteran, give name of War)
I Single, married, widowed, 6
Sex 722 -6/ or divorced (write the word) GL �C'"" Date of Death. �--c�-- 19
Age.-.$3 Years Months Days Birthplace 91i4y- -24-:
Cause of-Death LQ,�✓,
Certificate was signed by eei/r G�t,,t ,. '� M.D.
Address Li ,..kr3L,° ,z . 4 -Ld. .�"
Place of Burial (or Removal) `IeG..71/
(If body is to be temporaril held,4111in space lat ) "-.
:'. . ,
Cemetery L Gam._ max Ce-,1zeliry Date of Burial. %.,, 19 .t57
(If body is to to temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented o 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
Nu er, and on the b is thereof I HEREBY GRANT A PERMIT
to. .- / .. .. 7?u1-- �it z✓` ly 7 ,i- ' .. -. ig--/—,44 27 tX.
(Name) (Address)
the to hold temporarily and the body,
(Undertaker or person having charge of corpse) (lntetr-rgm ve, or otherw' spose of [stat 1)
Dated...v�,� t 19h,5' (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Stat subject to local
cemetery or other regulations), unless removal is by common carrier, in whieh lase 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 s=i�=� was--4_�C-�!
(Interment or Cremation)
(Name of Cemetery, Crematorium, etc.)
Section lot No. Grave No.__
(Signed) f2. -� �— _ Z,�r.2-€
( erson in Charge)
Address
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.