Hoag, Alfred NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
QSF 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.
Town, Village Registered No. 4-1
Dist. No. ......3294. County Oneida or City tiaroy
(If city, give street address)
Name of deceased Alfred Hoag Veteran no
(If veteran, give name of War)
Single, married, widowed, /`
Sex leale white or divorced (write the word) single Date of Death....376 ( 19.6.,2
Age.. _' Years. Months... Days Birthplace .NeUr..Xark..Statt
Caus of"Death.__.
Certificate was signed by -- �a-f,... M.D./,Y,�1,1?�.-_./�7,Q ,�
Address , ,,ife .,4,f;,,>L . ,]
Place of Burial (or Removal) r ,...! _ _4"le" : �r
(If body is to be temp rily held, fill in spec. later) �.
Cemetery .,;s.a ._._..rm"< LI:_y 7 T'. Date of Burial iL).c.41,r"1,_ / 19.6.7
(If body is to he temporarily held, fill In space later) t
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 Record with the above stated Registered
Numera and on the basis therfof I HEREBY GRANT A PERMIT
to.... - 4149(.-_. 1!r.T.1?(` .-..121.aa.r; I.. %v2e4t, .4:-e % a_.)...-.' ' -.. :tY
�4�ame) (AddrCss)
the yam ((-. to hold temporaril al d1 r c '' ti the body
ertaker of persdn having charge of corp9e) (Inter,remove or,ter vise is e of [state how])
Dated. J.i?i!C 19L,t.. (Signed) , _. t-C_._,—
Dep.Local Rggist r
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (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)
7
„...„1/./....-
&• .?.417;1:76,y,,e_e4_,,L.--
Person in charge must return this Permit to t , gistrai
or his District within SEVEN (7) DAYS from above dat_. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write ack'oss 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.