Traver, Isabella NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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. t O
Town, Village Registered No. �J
io
Dist. No. 5601 County Warren or City Glens Falls
(If city, give street address)
Name of deceased Isabella F. Trelver Veteran No
(If veteran, give name of War)
Female Single, married, widowed, i,�idowed 10/2 73
Sex or divorced (write the word) Date of Death 19
Age 77 Years Months Days Birthplace
Cause of Death Acute Coronary Thromboses
Certificate was signed by Richard Hagan M.D.
Address 325 Main St., Hudson Falls, NY
Place of Burial (or
pRemoyvlall) Pineview Cemetery, Town oc hueensburyz NY
(If body is to �1T]mtpoleW le rt. iiIl in space later)
Cemetery Date of Burial 10/5 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 a,ppearing 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 Carleton Funeral Home, Inc. Main St. , Hudson Fal ls, NY
to (Na Address
the '"• Bru"e I'letmoreme) to hold temporarily and Inter ( ) the body
(Undertaker or person having charge of core a nter, re rw, or pose of (state how))
Dated /4 — 19 l (Signed) "
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body 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 off- � -7— was 19I�3
(Interment or Cremation)
_1,—Z-+-c C 1 ,r,4 ,--
(Name of Cemetery, Crt-algid etc.)
Section '/ ,/ Lot No. J 7` fS Grave No. 2 ,
(Signed) -' �/ii f-t t-,( It 't_�
(Person in Charge)
Address //_ '41)4`l11?.,__.`._- " L -----'
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.