Willard, Beatrice NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fa" This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Vilrage, 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 Registe d No.
Dist. No. �� County wW^� or City 2Q
(If city, give street address)
Name of deceased Beatrice P. Willard Veteran NO
(If veteran, give name of War)
Single, married, widowed, Married
Sex Female or divorced (write the word) Date of Death 1-11 19 73
Age 7.1 Years .Months Days Birthplace Glens Falls
Cause of Death Pulmonary....Embolus
Certificate was signed by Dr.. Job;a....E... C.Ltnnin�,Tham M.D.
Address 52 par‹ st. Glens "ails , N.Y. 12801
Place of Burial (or Removal)
(If body is to be temporarily,held, fill in space later)
Cemetery P .n.e.v e.W....Cemeter.y Date of Burial 1-13 19 73
(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 a4ppearing 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 James F. Singleton, Inc 314 Bay Rd Glens Falls , N.Y. 12$O1
(Name) (Address)
theUndertaker to hold temporarily and Inter the body
(Undertaker or person having charge of corpse) (Int rye, o o herwise disp se of (state how))
Dated 1...,.1.3...73 19 (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 Permit (VS No. 62) is required.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date df CY t t'« " I was �l 19 -
(Interment or
/ r
i 2 ) �. �-�_c C [
(Name of Cemetery, (r ma u.m, els.)
. e; /Z
Section Lot No. C'-Z- 7 Grave No. t
(Signed)i\,- C
(Person in Charge)
`.-- /.. 7
Address
Peron in charge must return this Permit to Registrar
of his District within SEVEN (7) DAYS horn 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.