Peck, Beatrice 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. 3� C I County 4../4-fr?-s,.-Y✓ or City � �
(If city, give street address)
Name of deceased Beatrice peck ` Veteran No
(If veteran, give name of War)
Female Single, married, widowed,
Sex or divorced (write the word) Married Date of Death 12/17/70 19
Age 51 Year Months Days BirthplaceNew York
Cause of Death cardiac Arrest AdvaacedMulti ple Sclerosis
Certificate was signed ky .... William Tedesco MD M.D.
Address 117 pine St. Glens Falls, NY
Place of Burial (or Removal){��hei Glens `ails NY Town of Queensbury
(If body is totemptor nda,uf l tesga�etld
Cemetery .J7 IiJ`il l� Itl Date of Burial Dec .19,197019
(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 Jame•s•...F.....•S ngl•e•to.n•,..••.Inc, 314 Bay Rd. Glens Falls, NY
Undertaker (
ame (Address)
the to hold temporarily and Inter the body
Dated nderta e�'rlp®r;ep47dng charge loof corpse) ter, rem or of errors ispose of (state how))
11JJ OO 77��CCJI (Signed) /2 t,c,.....
/ 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) (9A2-205) sr
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of i. was 192 L
(Interment or Cremati n)
(Name of C metery, Crematorium, etc.)
Section SP 3 Lot No. 2. S. M'. Grave No. 6
(Signed) -t.sA-t
(P rson in Charge)
Address 3 S kr'SD.d' 1.4•� /" r/a.[.1 % /(� I
Person in charge must return this Permit to the Registrar
of his District within SEVEN (1) 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.