Ramsey, Howard NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ItW' 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. >6 7
f?
i Town, Village
Dist. No. 560/ ounty (I)
Name of deceased ru.A.4,,,,e
4 0.....„.or City
ive street addrezt)/7..
Veteran .47 &_/-i
Sex
(If veteran, givriTme of War)
Single, married,widowed,
or divorced (write the word) A' Date of eath -5 /56 19_79
Age _ FP al-12—Yr; Months Days Birthplace
Cause of Death — •
Certificate was signe by .
M.D.
Address
•
Place of Burial (or lz2)*eirval):714.....,&.... .
(If body is to m orar' eld, fill in ace later)
y9/ —7 -IQ
'Cemetery V7I'Llt,11-- ' t Date of Burial I / 19
(If body is to be temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after areful examination,
the sam- •earing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, have accepted the same
for re:istr.t.'on, have recor - it in my Local Recor ith the above stated Registered NFber, and o e basis ther f I HERE-
BY t R• i' A MIT 7.--- /,,,
to
(N e) (Address)
the „ to hold temporarily the body
(Unlerta er or pers having charge of corpse) (lot ove, or oth wi.,e die ose of (state how))
Dated /7 19 7/ (Signed)
Local Regi"rar —/-771 /
This Permit is ufficient for the Removal (and Interment or Cremation) of a body to any pa of the tate (subje'ct to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Per it (VS N . 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 c - 'jY7fra; was ji*tij 7%719
(Interment or Cremation) _-..
5i'f.- /4; � r��f
(Name of Cemetery, Crametnriuni;-ele-)---
Section Lot No. Grave No.
(Signed) L1-4' .L%`'4-7--I-0-€/
(Person in Charge)
\ /iC / `l
Address ��' /
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.