Higley, Ethel Form VS No.62. 7.6-55-10M(5G153)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
Mr A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany
each dead body transported by a common carrier.—Regulation 1, subdivision 1.
UNDERTAKER'S CERTIFICATE
3 i€)erebp ( ertifp that the accompanying dead body of Ethel Higley
Veteran' who died in the City of Dunk xx
(If veteran,give name of War) (City,Village or Town)
Chautauqua February 16 67 Female
7.
County of , State of New York,on 19 SC]t t Widowed
• , Age 77 New York
Color or race ' 1 � years months days, Birthplace and Cause of
el Death Peritonitis has been prepared for transportation
a
strictly in accordance with Regulation 1, subdivision 3,- as printed with this blank. Certificate was signed by
42 Dana...T't......'ti.h.eelo.ck , M.D., Address Fredonia, NY Date of shipment
.:l 19 ; Route of shipment Ame.7r.G.s c11 Airlines ; Point of
3 shipment u . -o., r�, Y, Point of destination Alb y.., N• Y, to Glens Falls, NY
(Signature of Undertaker) 1,,,i iNA.-^-
'° Dated February 17„ 1967 Address....2D....Cen,t.ral...Aue.. iredonia.p... Iew...X.ox1
ar. 'Cross out words not applying.
PERMIT OF LOCAL REGISTRAR •
DIST. No "' / Registered No
a.
3 Date of issuance . ebruary 17 1967
A satisfactory Certificate of Death for above decedent having been filed and recorded in my office, PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY. 61" /�f
(Signature of Local Registrar) ti' 44. -r . .Z.
Local Registrar of the a i t j of Dunk irk , County of Chaut a (qua r
(City,Village or Town)
State of New York.
Stir Only the Local Registrar (Deputy or Subregistrar) may issue a Burial, Removal or Transit Permit
jar Detach here and give part above to escort or attach to waybill if shipped by express
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of .., .C. zlsa..«- i ,..�"' 7' 19.. �.
(Interment or efj• - ,
7
i----
.-1 ." , -},--,:i—el Z,/^ -7'',.
t 77/7" ,-
(Name of Cemetery, Crematoria e ct )
Section `- Lot N. �` Grave No . 4/./
Signature 7;,----C---4":‘1.-- 4-k._Person in Charge) (Add )
Persons in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from above date. If no
person is in charge. THE FUNERAL DIRECTOR OR UNDERTAKER 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 Registrar of District
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.