McPharland, Peter Form VS.IL - NSW YORK STATE.. DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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 Registered No—_.�:.
Village
Dist. No....—.., County......A::b d t.; or City C o l on i e, NY
Peter I�lePharland of city, give street address)
j+�
Name of deceased Veteran
Single, married, widowed, (If veteran. give name of w.,)
Sex � Colors'' or divorced (write the word) Married Date of Death �17� 195
Age 31 Years Q Months a.....,....Days Birthplace Brooklyn? NY
Cause of Death Thwr,d, cleg.r. ..:o.1,1,g.DA e g.t ire body
Certificate was signed by J. Gregory Nealon
M.D.
Address Albany county, NY
Place of Burial (or Removal) Tawxl. of Q,ue ensbury I NY
(If body is to be temporarily held,fill in space later)
Cemetery P.�.1-,),_.ij,.;w (;emet cry Vault Date of Burial ,3/21/ 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 exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to ti• Edmond irous Ottawa Street, Lake George , NY
undo (Address)the to hold temporarily,and % .r the body.
(Undertaker or person baring charge,of corpse) (Inter, remov er othe dispose of[e how))
Dated 3 41-6./ 19.P.,- (Signed
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any past of the State (wsbject t local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
44(e.
ENDORS T OF SEXTON 1 P SON IN CHARGE
PREMISES ON WHICH IN WAD TS OR C TIO r
AZ 77
; .
/' Date of was 19
(Interment or Cremation)
(Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
( (Signed)
(Person in charge)
Address
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 UNDERTAKER MUST SIGN ABOVE STATE-
MENT, 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 OFI1.NSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.