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McKinney, Florence NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT fgr This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town, Tillage, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF )EATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. r'—., , Town, Village e istered• V Y )ist. No. ''--5 ©•1county or City (If city, give street address) Jame of deceased ... Veteran (If veteran, give name of War) Single, married, widowed,;ex• AC L. �K--• or divorced (write the word) .. j.,C_-414-4. -' .Date of Death 1 / 2-'/ 19 7, age 4,,`)" Years . No the Days Birthplace 2ause of Death Gl.. .... certificate was signed by . M.D. Address XY-&-x-Le . .litil /1,-, • )lace of Burial • Removal . ....4, If body is CO bet ►i raril d ace later) If body ._.....; .. .... �.,. ..... Date of Burial .//y 19..� .. If body 1s to be mporart e , i s ace ater the CERTIFICATE OF DEATH ontaining the above stated particulars, having been presented to me, after caref I examination, the (ame appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra• ion, ha corded it in my Local Rec rd with the above stated Registered Number, and on the asis the of I HEREB GRANT A 'ERMIT ' (Natty) )..7‘,A44..,k) (2 (Address he . . .1 4„... to hold temporarily and . .. the bo y (Undertaker or p r n ha}t1 charge of car se) , r ve, erwrse dispose of (state how)) )ated 19.7 (Signed) Local egistrar This•Permit is s fficient for the Removal (and Interment or Cremation)of a body to any part of th State (subje to loca/ cemetery or )ther regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. FORM VS. 61. (REV• 6/63) (3A2.323) ENDORSEMENT OF SEXTON OR PERSON IN CHANCRE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of Interment was 19 (Interment or Cremation) �t_ Al phnn su Ceme.f r. (Name of Cemetery, Crematorium, etc.) Section Sp. Lot No. D-6? Grave No. r � r (Signed) (P rson in Charge) Address (%YL-C-Ie -'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 UNDER- TAKER 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 UNDERTAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Registrars are required, under penalty, to report violations thereof.