Taylor, Grace NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
C ' 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 c,ceitegistered No
Dist. Na. i c I County or City
.� ' tl� (If city, give street address)
(.rtc-C G 1.. (c-C� .tom
Name of deceased Veteran
/ (If veteran, give name of War)
z-` - L----
Single, married, widowed; ;,, , . a L (_,
Sex.-�� or divorced (write the word) Date of Dgatt � 19_
'--
Age �' Years Months Days �i ` Birth ce- -_ `� , c �
Cause of-Death " t•c. -z-_.cc�a� ` "z-t',___ 7
Certificate was signed by �z M.D.
Address a'e`�
Place of Burial (or Remo a1-Z'L'�
(if body is to be temporarily held, fill in space later r
Cemetery � ,...�: ��— :ate.of Burial �-) � �V 19 �
Elf body is to be temporarily held, fill In space later)
The Certificate of Death containing the abo e 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 R,ecotd with the above stated Registered
Number,'ant, on the basis thereof I HEREBY GRANT A PERMIT , /' .
/ _ e-7
to �,' L�, 1- t_.ti-4�4-�1. •i7 ."--y. ' .i+�_4` J .'-G.
..mot...../.--� . ,.._
(Name) , `o (Address)
the to hold temporarily and _' ..>l-- the body
(Undo aker or erson having charge of co se) .(Inter,remove,gr otherwise dispose of [state how])
Dated 19. 7 (Signed) .` I-• ,_./.. `;_: cL - _,iL.Ls..'
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Sta e (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 WHICH INTERMENTS CAR
CREMATIONS ARE MADE
Date of + was it): 2 9 1912 r
(Interment or r^^— • I
(Na a of Cemet , .)
Section_..L_ MC)L- I Lot No. L Grave No.__
(Signed) ----
(Person in Charge)
Address 3 S af d-2 , 2i) t /v, Y
Person in charge must return this Permit to the 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 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.