Logan, Fred NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fiSF 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.
Town, Village Re istered No._.. yr
Dist. No.\-5Z..�.2. County.... or City
(If city, give street addr
Name of deceased l-.r� ..�,,_,.. R.�'L.� Veteran
(If veteran, give name of War)
Single, marj� gdd, w owed,
Sex ..... ... or divorced (write the word). .. . ......Date of Death /o9- " a 3 - 19.46
Age.... 5 Y Months Birt e
Cause of-Death - Zpest_ft,„.....4,4",
z
Certificate was sig d by.... `• M D
Address.,-.- -... _ .. 6-C :
Place of Buri (or Removal)...,....
(If body is to b e poraril het fl in spots t '
Cemetery-- ) ate of Burial..Ja " 2 192.4
(if body is to be temporarily held, fill in space later)
The Certificate of Death containing the above ated particulars, l ing been presented to me, after careful exami-
nation,•the same appearing to be COMPLETE, CORRECT, AN SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Re rd with the ab stated Re istered
sis
Nu er and o the ba i4 eof I HEREBY GRANT A PERMITxi/
``�� � � � �
) , / ( dress �
the to hold tempora ' y and t e l dy�
(Undertaker or person having charge of cqq'�pst) (Inter,remove o rw dispose of [state how )
Dated /A.-..12-.-4 19& (Signed)
Lo Registrar
This Permit is sufficient for the Removal (and Interment or Cremation of body any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in whit case a ansit 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 9f - J wasV c- / 7 19_
(Interment or Cam:Winn)-
)
t
,- / (Nap of Cemetery, Crematorium, etc.)
Section - •'1 a I.ot No./'Y C Grave No.
(Signed) li— "`-
(Person in Charge)
Address ` ) L. .::g r'
— _
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.