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Beckwith, Frederick NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT far 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. ---?J' // Town, Village Registered No. LL Dist. No. 5 l0 O/ County or City ,eQ (If city, give street address) Name of deceased 2 •. 't'zç1 4.-- :41.GlVeteran (If veteran, give name of War) Single, married, widowed, Sex or divorced (write the word) ..!L Date of Death ./, ,//' 19 76 Age a' Years _Months Days , Birthplace <� 4-f, Cause of Death ,�/Za.6z' _ C,l... �,��Certificate was signed by .e/., �-c-F-cep • ....... ., y� � � M.D. Address At,, �� Z (--e t- j Place of Burial (or Removal) Arvt*1 .,,,rc.e .�, (If body is to be temp y.psa'9y held, filJ,in space iat Cemetery .[ %[iYG& U Date of Burial ? 7('-/— 19 70 (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 th7e above stated Registered Number, an on the basis thereof I HER Y RANT�J A PERMIT i'1� 4"� ' �tQ, iy"[yz. ,), to A t� N .. �° 9 A( dress) the a¢�ZL to hold temporarily and the body (Undertaker or person havingg charge of corpse) Dated t lFr 19 .ZO (Inter, emove, or otherwise dispose of (state how)) C (Signed) ,( LRegj Ati This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any p; rt of the State (subject to oral cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VriiiNo. 62) is required. FORM VS. 61. (REV. 6/63) (9A2-2O5) 9© ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of� L 4 4'` "f was 7 Ze 9 O (Interment or ''--Tat 'n) (Name of Cemetery, C /`% Section cgzC7 Lot No. /e Grave No. (Signed) (Person in in Charge) Address Person i charge must return this Permit to the Iegistr 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. 3ECKWITH Lot No. 4�7 kddress 3 Liberty St. , Glens Falls, N.Y. Section No. 27 Dwner Fred M. Beckwith Plot Wah-Ta-Wah Date Sept. 30, 1932 310 Superficial ft. @ 60X = $186.00 Location East side of Arbor Vitae Walk. Bd. north by Grass Path; East by Glassbrook-Sawyer; South by Brownell. Dorner Posts yes 2emarks 2 markers Deed No. (and changes) 427 ?ayment Record Paid 10.4.32 0100.00; 11.23.32 $86.00 -}-4 e -CkC"-3 i.- - -f S - t-t, L'1 S c�fl-c l '4 53 Form No. 01 Record of Interments 1 James A. Beckwith //- % - .3 3 . 5 Frederick M. Beckwith (9/18/70) 2 Ella Agnes Beckwith /0--/ _ 3,2_ 6 3 4>cp0 7 l.J.kCy C.3(.c3%.1.‘+ti -1-1-a-5 ---- C./ i Daphne E. Beckwith (5/19/70) . IS•'1 8 cc.- -r 11 • a3- 4Prt Y"' / I ``i' i i II I ', 1 Z I I I Imo , <" 1I C+ I 1 I i i . 'I j r i .,-i 1� PCs i I 1 1 7f/� t v/TAk= vvi ,_ rr -41 , rec:erick 6r). CFase : Cerel)r!-1 '-fsruler cciderr c iler . o4, A-27, h Thh . h1ot ?se: Cuperete : .c:/ '7;2 er ed : e rt er • r