Ronning, Olga 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. O�
Town, Village
Dist. No. -- YO/ Count (� L�/AL- or City
If city, give street address)
Jt1-4
Name of deceased Oje(11-7441-17 Veteran
(If veteran,give name of War)
Single, married,widowed,
Sex - or divorced (write the word) Date of D_ r�i/�
A
197F'
Age 70 Years cy Months �-__ _-_ ----__ Days Birthplace
Cause of Death L f1--
1
Certificate was signed by ,! IG er_.�, M.D.
Address �U_. ii_g_ex.. )(---7
Place of Burial ( Remov "r—aw-,og- ,d...4.,�.,to.-.�
(If body is to be tem r rily held, fi�i fn space,later) / �/
Cemetery -_--(/.(rQ,�,�,1 4 Date of Burial k�./7 7 13' c ,
(If body is to be to orarily held, fill in space later)
The CERTIFICATE OF DEATH 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, ave recorded it in y ocal Record with hh above stated Registered Number, and on the basis
ther I H E-
BY GRA A ERMIT �/ ?v i r-n/ - (S. ' C
to
( l (Address) )
the • __. .. Na e) to hold temporarily and j"�� ''ci Ae__- the body
(Unlertaker or erso hav2ng charge of corpse) (Inter, remove' - other se disp tate how))
Dated /b 19___7e' (Signed)
This Permit is sufficient for the Removal (and Interment or Cremation) of a body It& ny part of the to (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
( --Z------:37(2'
Date of -"z-e was1� 19 7 ,T
(Interment or CrematiL'ti'-t-e-
1
'C(-X--92-e-
0r`
(Name of Cemetery, m,
Section � Lot o. Gr ve No.
c�A S`141.4.6/ 7
(Signed)
(Person in Charge)
j
Address _ 1
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 per3
are liable to a penalty of NOT LESS THAN FIVE D
LARS NOR MORE THAN FIFTY DOLLARS FOR TAft
FIRST OFFENSE. The law will be enforced. Local Regis
trars are required, under penalty, to report violations thereo