Haviland, Morrison 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. :3 3
Registered No..:__-...___..___....
3294 ONEIDA Town, Village MARCY
Dist. No. County ._ __or City
(If city, give street address),
Name of deceased.----------_..-----•.-_---_.Morrison Havilard_.-------------._�..__... Veteran
(If veteran, give name-of War)
Single,married, widowed;_' l/ _ - ' ,^�
male ( married Date of Death.fl ! — __19.1
Sex_.._.. ____.� _or divorced wrife�th word �_-_________.�.._.-._
Age 7I__•___---.Yea w 7__._ >basths: __2 --_Days- Bir place Queensb'ur N.
Cause of'Death_.................' ^. - -•-- -- - __.._._._..._.
Certificate was signed by.._.__...._----- '`� _-------------- - M.D.
Address.__ � �'
Place of Buria4 r>uatf ' - _
(If body is to b t ri h Id fill i pace a
Cemetery__ __ Lia �„r�2!xi .—_-..-__-_...-_---_Date of Burial.-�L- _... _ 19 6 6
(If body is tn-be.temporarily held; fill hi space,later)
The Certificate-of Death containing- the above sta -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 registration;-have recorded it in-my Local Record with the above stated-Registered
Number, and on the sis thereof I HEREBY GRANT PERMIT"
to.. ......._., ` &-- • _.�> ��PIlC1 -w- - -.ter
(A r
( ,'In (
the._ a2_ __w..._..to`xhold temporarily Ird= ___---......__ - .....__________the body
cc����Undert -or hivin c :of corps ) (Inter move r.Qt ' disp e of [state howl)'
Dated.J:Jt_c.04_ '._ .. .t 1 (Signed)."._...
Local Registrar
This Permit is sufficient-for the Removal (and Interment or-Cremation) of-a body to any part of the State-(subject to local
cemetery or other regulations), unless removal is by common carrier, in which casea Transit Permit (VS No, 62) is required.
Form VS. 61. (Rev, 6/63) (3A2=333)'
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date o� � _____—was%! � ' __19_ /`
(Interment or Cs. stion)
'
(Name of Cemetery, Crematorium, et .)
Section_ 7 Lot No. / )7 Grave No._ <j[_
•
(Signed) xt���
g (Person in Charge)
Address 2-4 -1.--
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 DIRECTb$S 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.