Frost, Celia NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
nr This permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration Distric
(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.
egistered No.
/o Town, V illage�y� /_ / , G
Dist. No. Coun r�, or City �s✓ ��✓✓ `
V!✓ If city, Biv t address
Name of deceased 2 Veteran
(If veteran,give name of War)
Single,married,widowed, it v 19
Sex " or divorced (write the word) ` Date of D 2� i i
Age or ti Years Months , Days Birt place
Cause of Death Cry' /7 e
Certificate was signed by Pti! et-4-6.•,,,,a M.D.
Address `
Place of Burial (or Removal / g .
(If body is to be tem rily held, 1 in spac
.:-_ 3
Cemetery _______ _ Date of B ial 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 careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE-
BY A PERMIT, ,®
,..,/
to
(Name) I ( ss
the "' o hold temporarily and `' the body
(Upaar.e4
taker or person hav g chargerpf corps �ry (}}�,,ter, r move, or erwise di a of a w)
Dated 04---- 19 / (Signed) L _
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subje 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 57-�� was 19
(Interment or Cremation)
5 /.1, t'ilt 4' 4.--
(Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
(Signed) li."7
erson in Charge)
-e 4°:2
Address t./ �/�c 11 / /!
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.