Dean, Mary NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. 5601 County Warren or City C. .en-5 Fa.1I,g Hospital,
(If city, give street address)
Name of deceased Mary F. ;lean Veteran No
(If veteran, give name of War)
Single, married, widowed, Married
Sex Female or divorced (write the word) Date of Death J.a.A. 27 19 70
Age 5.3 Yea,�r � ?, Monts 74 Days Birthplaf9eA7banY N.Y.
Cause of Death �"`zf"ec• -rwe-c t � f�l
Certificate was signed by Alexander Avrin M.D.
Address 32 Sherman Atrp Glens Falls N.Y.
Place of Burial (or Removal) .......Tlyn Q.0 enshury Warren Co, N.Y.
(If body is to be temporarily held, fill in space later)
Cemetery St A.lph.ons,u.s Date of Burial Jan. 30 1970
(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 Carleton Funeral Home Inc, (A.C.Wilson) . Hudson Falls N.Y.
(Name) (Address)
theFW) Xa.1 Director to hold temporarily and Inter the body
(Undertaker or person having charge of corpse) (Inter, remove or otherwise dispose of (state how))
Dated Jan.. .9--cr- 1970 (Signed) "" ��
( ) y�Y part a
e Steg. t( r Jcemetery
This Permit is sufficient for the Removal and Interment or Cremation of a d to n art of C e S to (subject to local 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) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of �-✓
r"ril.t rti was 19 70
(Interment or Cremation)
144, // P � y
,..„....„.„.„
(Name of Cemetery, Crematorium, etc.)'/
Section )F Lot No. /5 Grave No.
(Signed)
(Person in Charge)
Address J ri-c i of
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.