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Rowe, Beatrice 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. 73 ./l Town, Village Registered No. Dist. No.. . Gai �l!.l County ' a ryes.-- or or City Q ��' (If city, give street address) Name of deceased f/c .o ! .— Veteran 's - (If v teran, give name of War) Single, married, widowed, ,/ Sex.___,,1.:',.G- �--E-�-- or divorced (write the word)....Ai( Date f Death -2- `f 19C L Age 3.r Years Mo ths........ ............Days Birthplace Cause of-Death (�..t a� . . . .._ :u �,._ Certificate was signed by M.D. Address 4� ....,..., % : Place of Burial (or Removal C2-1(4.-. .1 .-1---4-t` 7 (If body is to be to orarily4eld, fill ace later) 6247 Cemetery r 2 Date of Burial 2 719.4.4 (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 samegr registration, have recorded it in my Local Record with the above' stated Registered Number, nd on t bas tifereof I H REBY GRANT A PERMIT �/ to .�_. ,. h ..?<_. 7 (Address) the y.- to hold temporaril and_. the body (Undertakerok person having charge of corpse) (Inter, r move, or o rwise di pgse of [state how]) Dated C-ki.,.. ,�r 19. (Signed) �,, .1_.. . Loca Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the tate (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 �(rc C 19 C k= (Interment or Cremi b5 (Name of Cemetery, Crematorium, etc.) Section_ Lot No. Grave No._______ (Signe .L‘L141 tCe,,7 L L( (Person in Charge) _( • Address j" {'L 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.