Brady, James 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 CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No. .3 .2--
CC Town, Village dz&t,,, '::,— ..&
Dist. No. ... 16 7 County or City
If city, give street address)
Name of deceased a Veteran
(If veteran,give name of War)
Sringle, arried,widowed;
Sex o divorcedm (write the word) . _ Date of eath 7�1`y 197
Age ____P Years Months , Days Birthplace
Cause of Death
--- -------- - - --- ------- -- - -----
Certificate was signed by 1(.4... - ,fl -_?� M.D.
.
Address a --- �S��-�L-� �7�
Place of Burial sr Removal) � ��`
_
-�} .
(If body is to be to 4o arily 1 fill ace later)
Cemetery Ai ` Date of Burial ,?. ‘ 19--
(If body is to be emporarily hel fill In space later)
The CERTIFICATE OF DE H containing the above stated particulars, having 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 registration, have recorde it in y Local Record with t e above stated Registered Number, an on the basis thereof I HERE-
BY GR A PERMIT ei
to ` t,78 ./
' /
( me) U ddress)
the _-- Z(/I'L�l� to hold temporarily and the body
(Unlertaker or p7o aving charge of corpse) (In/a emov , or o wi dispo of (state how))
Dated , . 19-7.i • (Signed) -'`"'�
Locaf egistra
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (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)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of ,--/ -.t 'ar %.t was 4' 19
(Interment or Cremation)
(Name of Cemetery, Crematorium, etc.)
Section VI./t--0 Lot No. ig71
Grave No.
(Signed)
(Person in Charge)
•
Address 35 1-" :1 .�,° v.: tea .
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
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 the Registrar of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDER-
TAKERS violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOL-
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.