Sherman, Pauline NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rir 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.
3202 Oneida Town, Village Utica
Registered No.
Dist. No. County or City
(If city, give street address)
Pauline Sherman
Name of deceased Veteran
(If veteran, give name of War)
Female Single, married, widowed, Widow Aug. 24, 74
Sex 7$ nor divorced (write2l�e word) Date of DeatlNew...york 19
Age Years :Morth�s Dag Birthplace
Cause of Death Cerebral'an .reneral Arte iosclerosis
Certificate was signed by.A.V. Johnston M.D.
Address Utica tL, .Y.
Place of Burial (or Removal) Glens Falls, N Y.
(If body is to be gratiyeV16 . tyce later) Aug. 27, 74
Cemetery Date of Burial 19
(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 James N. Bly Lankton, Townsend and Cronk 12 Steuben Park Utica, N.Y.
(Name) (Address)
the Undertaker to hold temporarily d Inter
the body
(Undertaker ger2� having charge of corp 4) jyter, remove otherwi dispose of (state how))
Dated ' 19 (Signed) ��/• 0,
4IrLoc l Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the State (subject to 1 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
r
Date of C -L1`21,•,�s4C'.z= as c"et 7. 19 7V
(Interment or �rcnn�r
7 r
(Name of Ce etery, Crokftittsetij
r
Section ..! � Lot No. Grave No.
(Signed) (/! '
(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.