Hyde, Charles Form vs.81. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 CERTIFICATE OF
DEATH, LEGIBLY,,�-. WRITTEN IN DURABLE/� BLACK INK. Town Re eyed No._
Dist. No .. tin 'k. .. �f-F-� t —or City , --r -e ,-4..4: ,
(If city fve street address)
Name of deceased... ar - :? .�1: � .: �l.t. ,r. V teran
_ 'n le, married, widowed, (lf v give mare, War)
Sex :Colo . . divorced (write the wordy z. � �' Date o ath.. . ..1 /L� •c.`...
Age.. ....�/ o .....Days . A I3 pl z ,///,...F.:....; . ..�%:.. y�
Cause of Death. � .... .c-. z.:s ‘",. rcc.1.,i:,,.(.....r.:,l.4:X : ...
�, ' :..x..G.4Z ---- M.D.
Certificate was signed b :.:� t... .:������'• .�1..Z.a.�..,�4.�: �
Address �:. :4: :sr '
Place of Bu ' .(or.Removal) ' G:�:e � 4 x � I'—�� <
(If body is to ar el All In apace later) L% e/ of Burial ..Z-4- / 194' ..
Cemete - . r. vZ �: ?4:d 4 Date
(If body to be tempor ly held,ell In space later) Gr/
The Certificate of eath 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 hay a pted th same for registration, have recorded it in my Local ord with the above stated Registered
N , and on si f IHEREBY GRANT A PERMIT C
4 � '1-. .cr,
►(Name) (ed ressy •-
the,. ... . :,,.-a; I to hold temporarily and fr}-a>.-ca-�'e '1 ... ..� �� .the body.
or person having charge cor ) ^ (Inter,remoy or ot�rwlae pantie pf tate bow
Dated.7aker
1Z�' ,1`Z 19.... .`' (Signed) yc,s,w. . '--Zserrlhh i �.4:2-6::;.--
Local Reglatrer 1
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Tate (eubject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of k 1 Uc�l� was 19
(Interment or Cremation)
r2 th112 ,(00,
V:2�E,Gc�
(Name or C! tery, Crematorium, etc.)
Section Lot No. /I/ Grave No
ry o ,
(Signed)
( rson in charge)
Address
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from
fro above date. Ifino person is in charge, the
FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the words
"No person in charge,," and FILE PERMIT WITHIN THREE
(3) DAYS with the Registrar of District in which
cemetery is located. I
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 re-
quired, under penalty, to report violations thereof.