Bovee, Frances 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 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,it Village Rec No. , . .G?/
Dist. No. O�(v�'/ County ....� A� or City (If city, give street address)
Name of deceased 4-e-e.. ' Veteran
(If veteran, give name of War)
Single, married, widowed, -
Sex .... or divorced (write the word) ... �- Date of Death 6 — a 19 .67..
Age G ti Years Months Days Birthplace
Cause of Death M.D.e-�G:„6-7 lam- -e----4' r-....
Certificate was signed by "'
Address � ��
Place of Burial (or Removal)
(If body is to be temporarily d fill space 1 er) 7
Cemetery .... Lr+ c-� - ate of Burial ,�—,,.1 19 Gy.
(If body is to�be temporarily held, fill in ace later) ,,
The CERTI • TE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same Appe ring o be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have lrecor ed it in my Local ecord with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
,Name) . (Add ess)
the .... t„„(i to hold temporarily and ... , the body
(Undertalc r r pe son having charge of cor se) (Inter,{move, rot rrs dispose of (state how))
Dated / 19(�?� (Signed) t 'ha it 6,... ./egi
Local egi ar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the St (s ct to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Pe ( R'^. 62) is required.
FORM V5. 61. (REV. 6/63) (3A2-323) -
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of g7ti was 3 19 6
(Interment
/44:
(Name of Cemet ry,
Section IT Raw Q Lot No. Q3 SO*Grave No.
3
(Signed)
C + I
(Person in Charge)
Address .35 1�'+ ort�u' Trio YR�X�, I 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 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.