Trombley, Felix Form VS No.62. (Rev.)4-11-63-10M (2B3-98)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
tar A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must
accompany each dead body transported by a common carrier.—Regulation 1, subdivision 1.
UNDERTAKER'S ERTIFICATE ,,--
1 I Hereby Certify that the accompanying dead body of :C C ' /°Zpd/'(e t G
Veteran* who died in the t� of Q ,
(If veteran,give name of War) (City,V ge or Town) ///
County of , State of New York,on I/ 19 4e�^ , Sex '_/ , Married-
g".
g Age .4..years / months days, Birthplace ti Nh D A-- Cause o
and Cause of
a Death '.~`{wit..= - - has been-prepared for transportation
E str' ,in accordance w' Re Lion 1, subdivision ' printed th this blank. Certificate was signed by
kG �'-` M.D., Address �E ..Da et of shipment
.B 19 ) Route�f shipment. V ;Point
i //v�
shipment. l ; Point of dentin S.4:Mn... .... .. „ aa'r...
it
y }((Signature of Undertaker)... .:e�.�G,'6�xeGt� Reg. No.
w� APR C Z
Dated 5 ���17 19 x Address � 9a .... ahr�5"-
*Cross out words not applying. , 7j/j.i.,/./7
PERMIT OF LOCAL REGISTRAR
DIST. No. / I/L' Registered No. 208 7
Date of issuance APR 5..19,66 19
A satisfactory Certificate of Death for above decedent having been filed and recorded in my office. PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY„ �,r ,
/fi t- tL:.e.ri '' • - s.
e Signature of Local Registr ) sLocal Registrar of the r. of , County of .'fa.r'
(City,V llage or Town)
State of New York. _
Imo" Only the Local Registrar (Deputy or Subregistrar) may issue a Burial, Removal or Transit Permit
i Detach here and give part above to escort or attach to waybill if shipped by express.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of was 19 (C.
(Interment or Cremation) 63:54
�ki 1riu , .i
N e of Cemetery. Crematorium, etc.)
Section Lot No 74 Grave No
' ""��41 ��'
Signature � '
(Person in Charge) (Address)
Persons in charge must return this Permit to 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 STATEMENT, write across the face of
the Permit the words "No person in charge" and FILE PERMIT WITHIN THREE (3) DAYS with 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 required, under penalty, to report violations thereof.