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La Point, Arthur NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT f ' 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. 52 Registered No. Dist. No. 560' County WARREN or CityGLENS FALLS (If city, give street address) Name of deceased ............A.R.TH.U.R LA Po I NT Veteran (If veteran, give name of War) Single, married, widowed, Sex MALE or divorced (write the word) MARR I ED Date of Death 1 —�9 19 70 Age 69 Years Months Days Birthplace NEW YORK Cause ofDeath MYOCARDIAL INFARCTION Certificate was signed0 y ROBERT A. REID, M.D. M.D. Address HARRISON AVENUE, GLENS FALLS, NEW YORK 12801 Place of Burial (or Removal f P I NE VIEW CEMETERY TOWN OF CUEENSBURY (If body is toltiNeiapv Avhebtkil pEssae later) 1 ••31 —n© Cemetery r 1 G t LLtteeee TT Date of Burial tt 19 (If body is to be 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 JAMES F. SINGLETON, INC. 314 RAY ROAD, GLENS FALLS, NY to (Name) (Address) the QNOERTA KER to hold temporarily and INTER the body (Undertaker or person having charge of corpse) (Inter r move, orTherwipewte. (state how)) Dated JA.N.UA R Y 30 19 .'7.( ....._.., (Signed) Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any 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) (9A2-204) ':+91 ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of '( '5v vGas 19/-2 (Interment or tC.s.e4nrrricrtir t � (Name of Cemetery, Crem,r,rium. etc.) 4.1 Section %�.�' Lot No. /4/9 Grave No. } f, .// (Signed) Z'�. _ � ,✓- _ (Person in Charge) Address /� n t'Person i charge must return this Permit to the Regis rar 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.