Snyder, John NEW PORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q 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. ..90
Town, Village
Dist. No. _, T(2./ County Vdr.-- or City
// If city, give stree address)
Name of deceased_._. �/,.. .. .-. . _ _ Veteran 'tee-'
(If veteran, give name of War)
Single, cried,widowed,
Sex _ __ . ._ or divorced (write the word) Date of Bath v2-o2 19_. 0
Age 7 Years Months Days Birthplace _..0 teealecet
Cause of Death .__ e.cs_
Certificate was signed S 7 _ ��/ M.D.
Address. /i��_.
Place of Burial (or Re oval) _.. t..,J.
(If body is to b�ytempor il y held, f n taw •
Cemetery !6 _ � , • Date of Burial --Ar 19.(0
(If body is t be temporarily held, fill in space lat
The CERTIFICATE OF DEATH containi he above stated particulars, having been presented to me, after careful examination,
the same appearing to be COMPLETE, C RRECT, 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 G NT A PERMIT J
to,, �- e za►,l�/ i - /36 1 /- .',
(Nam (Ad•ress)
the to hold temporarily and $ /",. , the body
(Unistowiter or person having charge of corpse) (Inte'remov , o of rwise dispose of (state how))
Dated_ -4 1970- (Signed)/7) . ,
cal Registrar I
This Permit is fficient for the Removal (and Interment or Cremation) of a body t any part of the St subject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS . 2) is required.
FORM VS. 61. (REV. 6i631 18A2-781
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
'.. 7
Date of as 19
(Interment or Cremation)
(Name of Cemetery,
Section of No. Grave No.
(Signed) &A)./,,yi,zu)
(Person in Charge)
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.