Cutter, Mary 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 WRITI'EN IN DURABLE BLACK INK.
Town, Village�� Re istered No v1-Q JP
Dist. No. __61 6 o f County_ '"� . or City „/Jr�
£ (If city, give street address)
Name of deceased ZefVeteran
(If vet ran, give name of War)
Single, married, widowed,
Sex /,,k44 . or divorced (write the word) Date of Death Z$ 19.47
Age____._t'� 7 Y . ,...M nths Day mp
irth lace__..
Cause of-Death , . . -+C ..._
Certificate was signed by� M.D.
Address ,. ---
Place of Burial (or Removal) , `� "I-Pe—if
�y-P t/
(If body is to be tern
held, to p o la r)
Cemetery Goy Date of Burial _ / 19.47
(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, a ter 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
Num and on t1,2basishareofA HEREBY GRANT A PERMIT � 6
.,e) (Address)
the to hold tempo rily and- the body
MAer or person having charge of corpse) n ,rter v wise dispos of [state how))
Dated '' � ...1 19.6y7. (Signed)- � ' al Reg g rar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pat of th State (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 qR
CREMATIONS ARE MADE
Date of C4was J /— —19- 7
(Interment or Cremation)
(Name of Cemeter Crematorium, etc.)
Section_ —Lot No. Grave No._
(Signed)
( erson in Charge)
Address
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.