Barber, Ernest Form vs.eL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No..... ....._............
Village L
Dist. No 1..-..... ...County EsggX, or City
�Testoort
(If r'.3., give street address)
Name of deceased Ernest Barber Veteran
(if veteran, give name of War)
Single, married, widowed,
Sex N Color :I or divorced (write the word)...`ddiS9.sawed. Date of Death..2./.27/6.5 19
Age 92 Years Months Days Birthplace iies.t.port
Cause of Death Qr.ereb ra.l...Thr.omlho.sz.s
Certificate was signed by Q.B Qw .F?.R...Q.Q Q. i>,....r.d..+ M.D.
Address West ?Qz:ts N,Y,
Place of Burial (or Removal) .P.S.XieV.1.e.w.....Cem.e.t.ery..,....Glen.s...F.a1.1.s.,...3.Vi.. r,
(If body is to be temporarily held,fill in space later)
Cemetery Pine i..ew Date of Burial 3./1/6 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 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 it....Nia...Marvins.,...Sons E11z.a 2.Q. .b.t.Rw.n.,....11..Y.a
'Jnde t body
(Name) Inter (Address) the
the r' gl,Gr to hold temporarily and
(Undertaker or person having charge of corpse) (Inte ,'remove,�or o, a dispose of[state bow])
Dated .2....3/..1/6 5 19 (Signed) d.a� Xed..{..:. i
Local
R
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (enbject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTENTS OR CREMATIONS
ARE MADE
Date of-' : '� �,� was ;'-/ 19 6,,
(Interment or Cremati )
).//'
(Name of Cemetery, Crematorium, etc.)
Section .— Lot No.pzy
Grave No.
•
(Signed) ���� °� /? L (1
(Person it charge)
Address 411 (
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 UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the words
"No person in charge," and FILE PERMIT WITHIN THREE
(3) DAYS with the Registrar of District 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 re—
quired, under penalty, to report violations thereof.