Mc Carthy, Caroline THE LEGAL FEE FOR THIS PERMIT IS 50 CENTS
Cs,m'Lf n
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STATE OF NEW JERSEY BURIAL OR REMOVAL PERMIT
K No
., _i 4 AO.t, May ] , 19_58 5
(City, borough or township and date) 8 .5..g"
The Certificate of death having been filed with me, as required by the laws of this State, permission °' a
Caroline West fD "E"a.
is hereby given for the removal, burial, or other final disposition �°f���+ —x,—_ �,0'o
MC Carthy age 77___, sex_EPma 1 e who died in ° � 1 4l7 on_ Mayll, 5 `.
19___ 5 0oa51 c.
Cause of Death Cerebral thrombosis _ y a. c
K� y � �
Proposed Place of Removal, Burial or N o °=rx'
other Final Disposition _________Pine View Cemetery Queensbury, N. Y. o ;0
Place Location o°"a
C x fD 6s
Funeral Director 5" o�E 5.
Robert F. Husken #1 �fD
944--Smith & Smith m 5 E 0
oo='o 0
Newark, N. J. /*"&2"1-#_ M '
(Address) (Registrar of Vital Statistics) ipbq
CCDpcfDDCD
PENALTY FOR BURYING WITHOUT A PERMIT, $5 to $100
42,4 , 7, A
1 7.40v-- 'JI A WeRE JERSEY
BURIAL OR REMOVAL PERMIT
fi
-Name of Deceased
eit:- 1 •
Date of Burial or other Final Disposition
a o f Su rintendent o f Cem etery or Crematorium
(Y,
This permit must be delivered to the superintendent of
the cemetery or crematorium where burial or cremation is
to take place, who should fill in the spaces above and for-
ward it within ten days to the registrar of the district in
which the cemetery or crematorium is located. Registrars
are usually health officers, city and borough clerks and
assessors of townships.
When burial takes place in a cemetery which has no
person in charge, the spaces above should be filled in by
the funeral director, who should write "no person in
charge" on the line for signature of superintendent of
cemetery and file the permit with the registrar of the
district in which the cemetery is located. The law requires
that this be done within ten days after burial.