Sleight, Mary NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL/ PERMIT
I« 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. / ,
/ /� // J Town, Village
Dist. No. _ �_l __ County ` . V or City �,
(�` If city, give street address)
Name of deceasedvd7 1\ �.0 2 Veteran
Ci (If veteran, give name of War)
Si le, married,widowed,
Ses� ,m�-A ----' or divorced (write the word) Date of Death �J 19.
Age £ _ Yea onths ____ Days irthplace )L-__. ,
Cause of D ath
/.,
Certificate was signed y __ _Q..,:-r,...... .... .. ... M.D.
Address
:,&7€.,._,L__Ct_,-, ,
Place of Buri or Removal �G<t..,
(If body is to b porarily held f'1 i pa a later) V'
Cemetery ___ L---k 0 JO-4A, Date of Burial___________f-.... ...77 19__2.f
(If body is to b temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,
the same a pearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for regis a ion, have recorded 't in my Local Record 'th the above stated gi er
Registered/Number, and on he basi hereof I HERE-
BY GR MIT i'�(, I --v -� /_ 6 Cam'�L/, 1.172/) i i:
/,, ( ame) ., address)
the �-( ,4 L`- 6 to hold temporarily and �� the body
(Unlertaker or p,ersj'' a ing charge of corpse)( (Inter, rem r oth rwise d ose o (state how))
Dated - 19..1 (Signed)
This Permit is sufficient for the Removal (and Interment or Cremation) of a bo o any part of th 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 grt--7t--I----7nz- was c'�',�/� 7 19 d
(Interment or Cremation)'
(Name of Cemetery, (?rear ium, etc.) —_
/'h4 __------
Section , g Lot No. Grave No.
(Signed)
(Person in Charge)
Address c °) .
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 ill"
charge," and FILE PERMIT WITHIN THREE (3) DAY`(?
with the Registrar of District in which cemetery is locate
t
SEXTONS, FUNERAL DIRECTORS and UND Ft
TAKERS violating the law relative to the return of perm'
are liable to a penalty of NOT LESS THAN FIVE DO --,
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.