Sleight, Mary Jane This"Stab" to be ke➢t by pers issuing Permit J
BURIAL PERMIT
1. Name of Deceased---_---_--
s
-- -
Sex.. _ ., Age,.. _... -
2. Place of Burial---- - - ----
S. Dale and Place of Death-__.-- .-.-_-•--- - -ua
----
Cause of Death
6. Certified by.... ....... = ..
------------------------------------------------ - -_.. -------M. D.
6. Undertaker.-...-..
--
Sold by C. E, --WALING,Laty Blank Poblisbe Albany, N. Y,
°4E. ! STATE of NEW YORK. Potm s
i CYJ
"y MS
'• . PERMIT.mb BURIAL R I A L
cl
41 o v v l- I
OE�❑
T 04 IX -11 o l Name of Town 1
''.a.°_, , (Village) and County( � - -
ii Xr�
W ° .w -- ------- --- A�!�!
(Dated,) . 19/etc
Z The Certificate of Death having teen furnished to me, as required b he Laws of this Stale,
E ya a,
40 Z 9 u a a 71 permission is hereby given for the Burial of
0 o d � .ts4.t�
r o,.e o
- my.. y�.,_ _/1 Age _( Ci Towns )
Sex.-. — „+.,�i. �/ who died of
41
WGO
W >a f r` , in the
a g• County ofC s L;17 a
.n — �- �.
0 ti °•" 9 ec e
Z of death beinga 4�f the cause
.c_Place of Burial._
�'g °' Undertaker or person) p
j 1a4 ,uat (Signed by)__
el' in charge of Burial, —
Qa Residence row , 1 ��'j� .t
(OVER)
_ (0f13cia1 Title)
BURIAL PERMIT.
Name of Deceased,
Person in Charge of Burial Ground or Crema-
tory must fill out this part, and file the same with
the Registrar of Health, within seven days after
the disposition of the body.
Date of Interment
Cremation —19
Signed
Filed 19
Registrar of the
of ----N. Y.
NOTE—This Permit is only to be issued for a Burial within the County where
the Death takes place. Cemetery Keeper,etc.,must fill out according to above
Certificate. In case no Person is in Charge of Burial Ground,the Undertaker must
fill out that part on the other side of this Permit.
Every Cemetery and Crematory are required by Law to keep a Record of all Bodies
interred or otherwise dicnosed of on the Premises under their charge.
BURIAL PERMIT BOOKS, TRANSIT PERMITS FOR CORPSE ON RAILROADS, REGISTEI
BOOKS FOR CEMETERY TO RECORD BURIALS AS REQUIRED BY LAW ARE PUBLISHEI
AND SOLO BY
CHAS.E. HOUGNTALING,
LAW BLANK PUBLISHER,
ALBANY, N. Y