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Parsey, Geraldine 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 bistrict (Town Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPUTE CER- TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. �t� Re ist red l owif, Village Dist. Na ©L.. County �� or C' (If city, give eet address) Name of deceased 104 Veteran (If veteran, give name of War) Single, married, widowed, Sex // or divorced (write the word�� Date of Death- -c2 — / 9.6.4 Age-_ 17_Year" ont D Birthplace- Cause of-Death Certificate was signed b .-z,,,..- _.__.` F ..... ........ M.D. Address ie Place of Burial ( moval) - � �: i (If body is to be temporar' eld, fill in spacer Cemetery ---P� ..�C' G �. Date of Bur 191e?.a of 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 registr ion, have recorded it in my Local Record wit the above stated Re i ered N „ :-L a... on the-basis thgrpofY GRANT A PERMIT to. to. /f 'am,/ (Address) the.. ' to h Id temporari nd 7 the body (Und maker or per on having charge of corpse , (Inter,remove or otherwise pose of ( fate how]) Dated — // 19., (Signed) Lo 1 Regist r This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any art 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. (Rpv, 6/63) (3A2-323) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS qR CREMATIONS ARE MADE Date of -1 -t; 22_ was /e I,-- /2_____ ) (Interment or Cremation) i / (Ta— t ( - -'" / (Name of Cemejery, Crematorium, etc.) ) -J ( r Section( 3,2 W lit No,-.-1/O Grave No. / (Signed) ' —/12 I(' V L f, 4.-,—- 4— - e t"'"-•e (Person in Charge) .,-.._.....7 Address C 4,-7/ 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, .o report violations thereof.