Sheldon, Jefferson i
_6. NEW YORK 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village Registered No.
Dist. No. 2201 County Jefferson or City City of Watertown
(If city, give street address)
Name of deceased John J. Sheldon Veteran W• W. II
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death March 11 , 19 70
Age 57 Years .Months Days Birthplace Penna.
Cause of Death Cardiac arrhythmia
Certificate was signed by Richard S. Lee M.D.
Address Watertown, N. Y.
Place of Burial (or Removal) Town of t ueensbury, N. Y.
(If body is to he temporarily held, fill in space later)
Cemetery pine View Date of Burial March 13, 19 70
(If body is to he temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to Herbert Benoit Watertown, N. Y.
(Name) (Address)
the Undertake to hold temporarily and inter the body
(Undertaker or person having charge of corpse) ( ter, remove or oth wis dispose of (state how))
Dated Marc12, 1970
(Signed) � �.�: MOSV(\...r
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to a6 part of the State (subject 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) (3A2-323)
• ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of�//'G(-6V' 1 ''was )1Z4-t /J 19 )
(Interment orT--
o �9
(Name of Cemetery, Ccentrrrari rr
Section ./ Lot No. /, k_ -Grave No. (
(Signed)
(Person in Charge)
Address
Pers in charge must return this I3ermit to the Regiskf
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.