Collin, Nellie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village Registered No.
Dist. No. 3.3..00 County ON.O.N.D.A.G.A or City SYRACUSE
(If city, give streetaddress)
n.
Name of deceasedC Veteran
. (If veteran, give name of War)
Single, married, widowed,
Sex or divorced (write the word) .. ate of Death ...r.... / 19 61.
Age gj. Years /�j ,� .Months Days / Birthplace
Cause of Death ' '. ..
Certificate was signed� �, . M.D.
Address i`'. y uetd
Place of Burial or Removal)
(If body is to be C porari y he d, in spat ater)
Cemetery ..r� „n� 7�,Q Date of Burial Y i 19 �_j,
(If body is to he temporarily held, ill in space later).
The CERTIFICATE OF DEATH containing the above stated particulars�s ing been presented to me, after careful examination, the
same Appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to k� 1 -�- CX...I .,T
.. . ...
Namre s�`� )
the .I,lr:. yn i1,�-. ) hold temporarily and the body
(Un ertaker or person awing c arge of c rpsg (Int r r mow , or othe se ispos o (state how))
Dated — f 19 to 1`� (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the State (subject to loca 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 WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 7-;r,=:fi was 42 / \j 19
(Interment oorCe iea.)
(Name of Cemetery, Crempicooemearp
i Ic
Section S' Lot No. y Grave No.
(Signed)
(Person in Charge)
Address ` /La�
7777
Person in charge must return this Permit to e 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 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.