Kestner, Francis 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 (�� C�
�- �0 C1-,c4 -e-,�J Town, Village /7
Dist. No. County or City ,L
t
If city, give street address)
Name of deceased_ __ V A -,-1/_� �t-.___- /C •Veteran
(If veteran, give name of War)
Single, married,widowed, • /
Sex /174-1-4"" or divorced (write the word) '2-7 -��-0C_. Date of Death ///7 19
Age Lc-Z.
Years Mon As Days Birthp ce F__
Cause of Death 1.C, -d. <--€ Lf.-ft--1 4-� Cx-��, -c. -c..i_ __
Certificate was signed by _._LLB'. _ / C f1- M.D.
(-
Address %7 —C/H-� . ,',, �y
Place of Burial (or Removal �.c. _ __.. C.,1_.4%-e
(If body is to be, porarily held, fi in 3
ace later)
Cemetery_.__..,,( 4 _.4 -- Date of Burial / t 19.___Zi
(If body is to .e temporarily held, fill in space later)
The CERTI ICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,
the same appearing to be COMPLETE, CORRECT, AN SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for registrati have recorde 't in my Local Record i the above stated Register Number, and on e b sis thereof I HERE-
BY GRA PE IT
to -� 1 .
(Na e)� ress)
the to hold temporarily and the lsody(Unlertaker or pere of corpse) (Inter, re , or rw'se ispo a of (state how))
Dated J�
19 (Signed) Local Registr /
This Permit is7nvincharr
sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ubject 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 of94-47*-"*--4N was � 9 19 /
(Interment or Cremation)
(Name of Cemetery, Greittistetc.)
Section t-di-e Lot No. l Grave No.
(Signed)
(Person in Charge)
Address 4%6j
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.