Comeau, Charlie 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 :_:mary 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.
Town Villa Registers No.
Dist. No. / 7 County 4 . 4 .....�:- . or City gt 1 A �r
ti (If city, give "rest address) �,
Name of deceased z2.:C:�'- -� . r,,,, - „-1
.• - �.,,,,-.-.. Veteran
f� Single, married, widowed, c (IF veteran, give name of War)
Sex -.. � 2 or divorced (write the word). r .... -.'r - Date
of h 5-'" 19.�A e "4., Y '-Months / Days Birthplace.� ���:� �7../ P
Cause of-Death
Certificate was si ed ... ... . �� %., p-1-,- ` M.D.
Address :. ......... ., .4.,:`ice,, ( .. "
Y
Place of Burl or Removal). •
'� „
(If body is to b em r riff dt.fill i " pace later) ��� ro'
Cemetery., ? 1. _.0-e.<4.,e.c ..,,:.-.P.,:K: �z. i;�,.. to of Burial ---./' 1947
(If body is to be temporarily hel II In space later)
The Certificate of Dea containing the above state par.:culars, vino- been presented to me, after careful exami-
nation,,the same appearing to be COMPLETE, CORRECT, A D SATISFACTORY AS REQUIRED BIs LAW,
I have accepted the same for registration, have recorded it in my Local Record with the abov stated Registered
Numb , and on the basis thereof I IgREBY GRANT A PERMI
to. :.'a to-T. `---- ,, 4---r- -ter ... ?.. f-' �L'l �""�t�
4,-"th:,---,
dr _the.... :42-1-4C,:tf.R,.-.. c•� i '` 6' !111 temporal.' and the ody-
4 aater r person Navin charge of c `— (rater, rempve, or O ise dis [staff w}�
Dated off" :!:•:‹ 19 ... (Signed)- 14.-4 Q.2 �_p.�l� �...... . .072 '
•-, / Local Registrar
This Permit is su itient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to al
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No, 62) is requir
Form VS. 61. (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of k ----- —7--
s /0�K ( 19 ('7
(Interment or Cremation) /
_
(Name of Ce ery, Crematorium, etc.)
.......---- ,.
Section ( ( Lot No. •z 7 Grave No.____
(Signed) _
( erson �2 harge)
Address
‘ , ;,, -- C-2<�
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.