Alkes, Eva 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. „2--
Tuwn, Village
Dist. No. 6./ County or City
If city, give street address)
--�Name of deceased .0 _ Veteran
(If veteran, give name of War)
Single, married,widowed,
Sex or divorced (write the word) __ A Date of Death 3 19.41.
Age Days Birth 1 ce g �--,.-- Years _-�} , Months y �p ����� %
Cause of Death �:
Certificate was signed by ___ ___ ___ __________ ___ M.D.
Address
Place of Burial (or Removal) c;r_ _ _ .
(If body is to bet por rily held, fillce at )
'Cemetery _` �1 �; < � ( _- Date of Burial .-1 / — 19._
(If body is be temporarily he fill in s ce later)
The CERTIFICATE OF D TH containing the above stated particulars, having been presented to me, after careful examination,
the same appearing to be OMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for registratiog;' have reco} JJ
' in my Local Record with the above stated Registered Number, and on the basis thereof I HERE-
BY GRA �T
to �, 3 ��% , e! j
Nam� (Address)
the /n (1(-t1". ---- to hold temporarily and t `- - the body
(Unlertaker or perso awing charge of corpse) (Inter, r owe, or otherwise ispos of (state how))
,Dated , _ (,_c 19.2i (Signed) _
This Permit is sufficient for the Removal (and Interment or Cremation) of a o to any part of a State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case ransit 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
1 , . o
Date of 1 / `' / was 19
(Interment or Cremation)
> j)�c cL Hl /C- / �c_ �d yi C
(Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
(Signed) 7-`
(Person in Charge)
VZ I✓('i
Address l✓ rn,) 1-4//7 *
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 f
charge," and FILE PERMIT WITHIN THREE (3) DAYS
with the Registrar of District in which cemetery is locate .
SEXTONS, FUNERAL DIRECTORS and UND
TAKERS violating the law relative to the return of permi t
are liable to a penalty of NOT LESS THAN FIVE DOIl1
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.