Martindale, John i
Al
y Form 5
E STATE OF NE\V YORI(
m
. BURIAL PERMIT
,, m Town (Villje')-of Fort Edward, Washington County �,,--,,,-, ._ C' 19L.3
6
The certificate of death having been furnished to me, as required bp the Laws of this
y State, permission is hereby given for the burial of w
t fa
o ( a
t Age �� y ' who died at Town (V11lag`e J of Fort Edward, in the County of Washington,
on i'"�' _ 191 ; the cause of death being ,� - r��"2-`-'
Place of burial Sc"� - `�
\kQ Undertaker or person l2-.—� Signed a ` `�- ---
*. in charge of Burial. } Town Clerk and Registrar of Vital Statistics
Residence /-4'—`.fit.` '��_"-c-`' /
L Fort Edward, N. Y.
BURIAL PERMIT
Name of Deceased
Date of Death
Cause of Death
In the Town (Village) of Fort Edward, County o
Washington.
NOTE—This permit is to be kept by the cemetery keeper where th
body is buried. It is to be issued on the filing of a death certificate
certified to as required by Section 23 of Chapter 661,Laws of 1893.
NOTE—Burial Permits and all Blanks are to be procured of Tow
and Village Clerks and Boards of Health,for the registry of Birth:
Marriages,Deaths and Burials