Beckwith, Daphne NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
re 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.
<72��
Town, Villag Registered No.
Dist. No. . �� C unty j or City .....,, )7 v-
(If city, give street address)
Name of deceased eteran
(If veteran, give name of War)
Single, married, widowed,
Sex ../D or divorced (write the word) /14 -t /-01/Date of Death ...... -/"Sr—
19 .70
Age Co Years the Days Birthplace ��-�
Cause of Death =1 e — gre4".11"
Certificate was signed by 1 ' 7 -0--- -e -7-- M.D.
Address
Place of Burial (or Removal) 70t1`mac— �',l t
(If body is to be to rarUy held, fill in space er)Cemeteryfir' 4�i te a of Burial . r7-7 19 7 0
(If body isto 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 rec ded it in my Loc Record with the above stated Registered Number, don the basis thereof HEREBY GRANT A
PERMIT _
to
a .e) (address
the j to hold temporarily andc- __-,f.-e-Z . the body
(Undertaker or person having charge of corpse) (Inter, move, or erwt isp a of (state how))
Dated '5- - /..-.1F' 19 20 (Signed)
LockRegistrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any rt 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) (9A2-205) .,_:..r✓ .y..9)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 4' 'Fc-`was ' � 19 a
(Interment or —.
izrie‘
(Na f mete
Section 69, Lot No. " Grave No.
(Signed)
(Person in Charge)
Address
drell‘
Pers in charge must return this Permit to the Regis
of his District within SEVEN (7) DAYS horn 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.
ECKWITH (111) Lot No. 427
ddress 3 Liberty St. , Glens Falls, N.Y. Section No. 27
Iwner Fred M. Beckwith Plot Wah-Ta-Wah
late Sept. 30, 1932
310 Superficial ft. @ 60' = $186.00
ocation East side of Arbor Vitae Walk. Bd. north by Grass Path; East by
Glassbrook-Sawyer; South by Brownell.
orner Posts yes
.emarks 2 markers
reed No. (and changes) 4.27
ayment Record Paid 10.4.32 $100.00; 11.23.32 $86.00
abci. becx0.3►A-- q0; L. cam.
Form No. 01
Record of Interments
James A. Beckwi th //- (I- .3 3 . 5 Frederick M. Beckwith (9/1R/70)
Ella Agnes Beckwith /0—/ _ 3.2_ 6
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Daphne E. Beckwith (5/19/70) ''. j$•'jc� 8 �`'�D )
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Lot 427 aec. 27 ;eb f =h Ali :'1ot
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ec • 5 15/70
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