Saville, Donald 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. 289
198 Albany
Town, Village Registered No.
Dist. No. County or City.....1.1.. ...H0.1..I.aD.d..Av.en.ue.,...A.1.banyr,...New....Y.....
(If city, give street address)
Name of deceased Donald B. Savi 1 le Veteran WW 1 1
(If veteran, give name of War)
Ma I e Single, married, widowed, S i no l e 7/27 73
Sex or divorced (write the word) Date of Death 19
Age 72 Years.., Months Days Birthplace Vermont
Cause of Death Ca rc I noma of stomach primary with metastases
Certificate was signed by Edward Merz ig M.D.
Address VA Hospital , 113 Holland Avenue, Albany, New York
Place of Burial (or Removal) .. . .. Town of Queensbury, Ne— York
(If body is to be temporarilyheld, (ill in space later)
Cemetery West Glens Falls Date of Burial 7./30 19.,73,
(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 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 Potter Funeral Service g +
to 13(, W .rx:en...Str..ee. :,.... . ns..Ea.t..t.s,...N.ex�...York
Undertaker(Name) (��dress�
the to hold temporartl d Inter the body
(Undertaker or person Navin charge of corpse) (Inter, remove, r o wise dispose f (state how))
Dated 7/27 19 73 (Signed) . ‘ ;,C.aG : ..
oral Registrar
This Permit is sufficient for the Removal (and Interment or Cre tion f a body to any part of the State (subje to local cemetery or
other regulations), unless removal is by common carrier, in which Ea 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 , was ' <., i9 ;
(Interment or Or n)
• �<' �.
(Name of Cemetery, Crematorium, e.tG.)
Section Lot No. Grave No.
(
(Signed)- o. -
(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 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.