Bannon, Isabel 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. /�-�-�
No. <J
t'O�� Town, Village
Dist. No. County or City p,.... ..._,,istered
l�
/� (lf city, give street address)
Name of decease! Veteran
(If veteran, give name of War)
Single, married, widowed
Sex_ -��t f or divorced (write thew to of 9, h .. . .... . .... . 1 .er
Age � 7 Y ars. Monthly Birth lace
Cause of-Death._. - .
Certificate was signed by. c-' -z tom— M.D.
Address _ _, -;---
Place of Burial Removal) .,::-2.1
(If body is to be tetnporar. held, fill in later
Cemetery --e--r�--e- —- -�-� Da a of Burial /)..1..... ....6 19.66
(If 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 s me for registration, have recorded it in my Local Record with the above stated egistered
N , and on t sis ereof I HEREBY GRANT A PERMIT i( 47
) (A ress)
the.... —t to hold temporarily and .... . e body
(Undertaker^or person having charge of coryysel, (Inter, emove, or o( rwise dispose of [state how])
Dated `� 19.SP (Signed) �ryickGO
-,
Local egistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to 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, 82) is required.
Form VS. 61. (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS CAR
CREMATIONS ARE MADE
Date of_— /t was_ �1�`/ �' 19 41
(Interment or Cremation)
(Name of Cenjetery, Crematorium, etc.)
Section?, Lot No Grave
(Signed) % Z GL .. c .
(Person in Charge)
Address i
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.