Lemery, Alice 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. . l`'.?
Dist. No. 5601 County Warren or City Glens Falls Hospital
(If city, give street address)
Name of deceased Alice M Lemery Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the word) Married Date of Death July 1.1 19 .70
Age 76 Years 7 Months .10 Days Birthplace Canada
Cause of Death 0varan Carcinoma
Certificate was signed b Richard Hogan M.D.
Address 325 'lain St Hudson Falls N.Y. 12839
Place of Burial (or Removal) Twn Queenshury Warren Co. N.Y.
(If body is to be temporarily held, fill in space later)
Cemetery St Alphonsus Date of Burial July 15 19 70
(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 recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
toca;r.le.t.on...F.uneral Home....In.c.......(.A..C..Wil.son) .Hudsaon...Falls...N..X..
(Name) (Address)
the Funeral Director to hold temporarily and Inter the body
(Undertaker or per on having charge of cor se) (Inter, mov or of rwise dispose of (state how))
Dated _July . 19 7p0 �?(Signed) .....<. i//
Local.
Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a boildy 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. 6/631 (3A2-3231
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON < ICH INTERMENTS OR
CREMATION ARE MADE
•
Date of was � � 19 7 G°
(Interment or Crema( n)
kl-
1-11,1,„,,
(Name of Cemetery, Crematorium, etc.) f
Section kCi,i4. Lot No. / C Grave No. //
(Signed)
(Person in Charge)
Address -?_'Fi -W I ,tt 2' rfz, N
i Registrar
Person in charge must return this Permit t o the e eg trar
of his District within SEVEN (1) DAYS from above date. If no
person is in charge, the F NERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOV STATEMENT, write across the
face of the Permit the wo;ds "No person in charge," and
FILE PERMIT WITHIN THREE (3) DAYS with the Registrar
of District in which cemetery is located.
I
SEXTONS, FUNERAL 6IRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS T AN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS OR THE FIRST OFFENSE. The
law will be enforced. Loc�l Registrars are required, under
penalty, to report violation thereof.