Deyette, Nathalie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
1.4r 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. 4601 County Schenectady or City Schenectady
(If city, give street address)
Name of deceased Nathalie C. Deyette Veteran
(If veteran, give name of War)
Female Single, married, widowed, Married June 7 70
Sex or divorced (write the word) Date of Death ..N.Y. 19
Age 52 Years Months Days Birthplace
Cause of Death Coronary Thrombosis
Certificate was signed by Dr. Shields M.D.
Address 1548 Union St.
Place of Burial (or Removal)
a�l Glens rails, N. .
(If body is to be w nporatily d, fill in space later) June 10, 70Cemetery TTii• ,��P11 Date of Burial 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
toPERMIT Singleton Funeral Home 3X4XUARAXIMILITXXX4 Glens Falls, N.Y.
(Name) (Address)
the Undertaker to hold temporarily and Inter the body
(Undertaker or pe son charge of corpse) Inter, remove, or erwi dispose (state how))
Dated June o, 1970 g 19
(Signed) . . ,. . ... ... .. ..... ---'2—.,
Local egistrar
This Permit is sufficient for the Removal (and Interment or Crematio 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. 6/631 (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 9T '(MJ11dwas i Q �0 19 70
(Interment or Crema on)
e
j
(Name of metery, Crematoripm, etc.)
West
��ll +� haif
Section 1- QQ 1,A) �S Lot No. i'i A 0 Grave No. .
,k Si gned)
(Person in Charge)
Address 3 3rDv2 2) )iL1 TX.
Person in charge must return this Permit to the Registrar
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.