Sawn, Mary NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rar 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. 15
Town, Village
or City Registered No.
Dist. No. County
5726 Washington Hudson Falls
(If city, give street address)
Name of deceased Mary T. Sawn Veteran
(If veteran, give name of War)
Female Single, married, widowed, Widowed Aug.
Sex or divorced (write the word) Date of Death , 1973.
Age 68 Years Months Days Birthplace New York
Cause of Death Coronary lrifarc.
Certificate was signed by Milton J. Greenberg M.D.
Address 3 2 Pearl St., 1ludson Palls, N.Y.
Place of Burial (or Removal) Town of Queensbury, N. .
(If body is to cttempgratily b luh nil in space later)
Cemetery . A1pn0 Date of Burial Aug. 11, 1973
(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 Potter._Funeral..Service 136...Warren...St... ...G Falls,. N.Y..
undertaker (Name) int4 � ss)
the to hold temporarily .r/ 40, the body
(Undertaker or person having charge of corpse) r, remove or 4 .tsp^, (state ho ))
Dated rlUguSt 10, 19 7.3 (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 of Lr was Q nt" (I) 19-3
(Interment or Crematio
Ai. .t 11
G.mse,11_
(Name of Cemetery, Crematorium, etc.)
Section Lot No./kg/4Grave No.2
(Signed)
Person in Charge)
Address 35 j "IL ?Q i, ,ii I
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.