Bickley, John 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 r.imary 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.
Imx2MVxxx
Registered No.
Dist. No.. 3202 County Oneida or City Utica
(If city, give street address)
Name of deceased LliQt t..FA..$l.ckley Veteran NO
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death October 4 19 67
Age 66 Years 2 Months 1 Days Birthplace Elsmere, England
Cause of-Death Gel arteriosclerosis
Certificate was signed by V..Johnston M.D.
Address UtQa„..IgeTeitQrk
Place of Burial (or Removal) 1 ort of Queensbury
(If body is to be telnporaril held, in space later)
Cemetery P,l-rle V1ew cemetery , Date of Burial October 7 19 67
(If body is to be temporarily held, fill to 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 same for registration, have recorded it in my Local Record with the above stated Registered
Number and on the basis thereof I HEREBY GRANT A PERMIT
to ikton, Townsend & Cronk l2 Steuben Park, Utica, New York
(Name) (etdd ess)
the flmexa.1...11,2atC to hold temporarily and intor the body
(Undertaker or person having charge of corps,t�) Inter, o- or otherwise dispose of'[state how])
Dated October 6� 19 ( (Signed)..0027.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Sta a (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)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WWCH INTERMENTS OR
CREMATIONg ARE MADE
Date of%-��1E- - / was_[:-'G ~/ 19 7
(Interment or C, .....i...,}
- /,2442 -�o f Cemetery,Crematorium, etc.)
Section �` i T.ot No._ 7Grave No.
- f
(Signed) / /: l:_,- _ /- -t7
- -71- C-
"' (Person in Charge)
r
Address ''7. 0 /'j�" :`h --
Person in charge must return this Permit to th egistrar
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.