Aikens, Lena i
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Ea?' 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 COMPL E ER-
TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
��--// Town, stage, a istered No
Dist. No. .5.Ia Count Lt) -41 ..er City
(If city, give street addr
Name of deceased... �-" Veteran T2.G, d
(If veteran, give name of War)
- Single, married, w,idowect '
Sex ffe---2-K -t'/� or divorced (write the word) .._ ;Date o eat ....F —..,a2.. - 19
Age 9 rs. the Days Birthplace..._:.. ... A
Cause of- ath- ... .
Certificate was si ne by Cx ..c- 'fit.-t-•.- _.. . _.. M.D.
Address_ _
Place of Burial (o Removal)... ._
(If body is to be to or my held fill,mspaca late )
Cemetery .L.l Date of Buriap:4 I j 19i'9
(If body is to 4e temporarily held, fill in space later)
The Certificate of Death containing the above stat 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 ecord with the a ove stated Registered
34
Num r, and on the basi ereof I H EBY GRANT A PERMIT
p � (N ® � (Address) c-:7,'.'
Lite/ '�24.-- . - Ch1 to hold tempor4 nd dy
rtaker or person having charge of cor�ppse) . (Inter,remov , erwse of [state how])
Dated.- . c3..!I 19..(a. (Signed) .. .
` Local Registrar
This Perm' s sufficient for the Remo al (and Interment or Cremation) of a 4,y to any part of the State (subject to local
cemetery or.ot er 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 WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date - 6. E'er ,_-f— was f ,7 /' 19_ 1
(Interment or��M
Y
•
Ci..�-
(„,,,,,,fial of Cemetery, corium, etc.)
Section__ -" 7 • Lot No.'.409 Grave No. __ 7
(Signed) 7 ,-.1� ,--` '/`-''.-2-4--1
l(t
(Person in Charge)
Address , < 1 2-,'.,...
Person in charge must return this Permit to the Reg• rar
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.