Bishop, Arthur 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. ?
J J ---own, Village _
Re ister No. �,3
Dist. No:6 d/ County G� o City ..._
//' (If city, ve street address)
Name of deceasedC "V veteran
(If veteran, give name of War)
Single, married, widowed, A, vvv
Sex /21..-r or divorced (write the wordr..74" - - -- Date of D h , - 7 19.
Age 7k' Years_ Months Day $ikhplace Lei:‘:. ,
Cause of-Death
Certificate was signed i vZ-c-e . . ' M.D.
Address. sc..{ leZ___L-17.
Place of Burial (or Remo ..
(If body is to be temporarily held, fill spate lat )
Cemetery , - ' Date of Burial 19.6.:C
(If body is to be temporarily held, fill to 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 registration, have recorded it in my Local ec d with the above stated Registered
Nu , d on the si thereof I HEREBY GRANT A PERMIT
to.. .� c two . c -C /
ame) (A./ess)
the �� to hold temporarily and..:._ the ody,
(U aker�r,person having charge of co9esel, (Inter,r me,or rwise �s se of [state how])
Dated — 19.606 (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body t any part of the tate (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 --ry =' µ s-f was 19 .,
(Interment or'Erematiotr)
l.. y `
(Name of C etery, Crematorium, etc.)
/d i
t
Section Lot No. 1-'I G Grave No.—_.2
(Signed) _ 4(c t L"" `._. V `' 2
(Person in Charge)
Address (1f+ y ` ` -- cit
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.