Hewitt, Isabelle 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 COM LE CER-
TIFICATE OF DEATH, LE IBLY WRITTEN IN DURABLE BLACK INK.a
Town, i agvp '•istered No.Dist. Ni... County y
oT"eif
(If city, give street address
Name of eceas Veteran -
(If veteran, give name of War)
Single, married, widowed,
Sex .._ or divorced (write the word).... _Date of Death 7J Li IL(
Age 4-- ars s Day . rt'�1 : e ,... . ._..f,/
..4
Cause of-Deat •* --4,... ., m ,. - 's , s `,
Certificate was sign d y... . . _... ' , M.D,
Address es- ..i
Place of Buria for e -- -�--��'
(If body is to be to ora Id, I i ac later
Cemetery .... ...... Date of Burial 7 14
(if body is to be mporarily held, fill In ace later)
The Certificate of Death con 'ping 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 a. -• • cepted the s. - far registr.u' on, have recorded it in my Local llecord with the abo e s ed Registered
Am
Mum % n. the , t ereof I I REBY GRANT A PERMIT iv •
.
yi21 e) � � ,ddress)
the ,r' ' I u.l to hold temporarily 1 ♦ -.-- t dy
(Undertaker or person having charge of co s (Inter,remove, or • . e ' s f [state how))
Dated "2 r c— 1�� (Signed)
oc. -egistrar
This Permit is sufficient for the Removal (and Interment or Cre ation) of a body 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 19 (Oki
or Creme' ) V
)
(N e of Cemetery, Crematorium, etc.)
Section____ ./I - Lot No. 4- AO Grave No. 't.5
(Signed)
(Person
in Charge)
Address 3 ifiN '4 14- U •
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.