Sellick, Fred Berm v&.i. 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 CERTIEICAATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No. .._...._......_._
Village Dist. No..r..7.2.6....Cvcaty Wash* or CityHudson Falls, t
. Y.
(If city, give street address)
Name of deceased Fred Et Sellick Veteran N o
Single, married, widowed Of veteran. give name of War)
teor divorced (write the word)Male Color LJhy rd) Widowed Date of Death...J. e 17 $ 19.56
Age 91 Years 1 Months 9 i..Days Birthplace Tn. of Kin zsbur, ,NY
Cause of Death coronary Thrombo si s
Certificate was signed by Si cfiauri.d Weiss M.D.
Address. Hudson Tra:lis, ' .Y.
Place of Burial (or Removal) T41.....caf Q,ueea.sburg, N . Y.a
(If body is to be temporally het $ll in space later)
Cemetery PineView Gem. Date of Burial thitl.e...20 0 19..56.
(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 ih f I HEREBY GRANT A PERMIT
to Carleton Funeral. Home, inc. Hudson Falls, N . Y.
Undertaker Elk,d W. 'Wilson (Address)
the : to t o hold temporaril- a the body.
(Undertaker or person having charge m
corpse) ter,remove, a se snore o to how))
Dated' a'..tT10....2.Q.,. 19...5 . (Signed) ,•- ..
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 P.nnit (VS No. 62) is required.
ENDORSEMENT OF SEXiUl4 OR PERSON IN CHARGE OF
PREMISES ON WHICHAgIERMENTS OR CATIONS
MADE aLlic-12, .
Date cve-e.' ,c7 y2.•-‹ �.. was ` 19 c j--g
(Interment o
/1
--: i;*:''..-? '/,,-
G' (Nsse of Ce tery, Crema rium, etc.)
•
Section / Lot No. [S:2► Grave No.5
(signed) C l +� ����' : 4
(Person in charge)
Address 6C' e1?- s73z,,tov=4„„47_ .
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 OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.