Putnam, Muriel 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,
Vilrage, 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.
Town, Village Registered No. 1
Dist. No. 5601 County...warren or City Glens....Falls,....N.Y......1.26.01
(If city, give street address)
Name of deceased Muriel C. Putnam Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the word) Marr.ie.d Date of Death 4.-2- 1974
Age 5$ Years Months Days Birthplace G1ena...Fa11s.,.N..`r.
Cause of Death Pulmonary Edema
Certificate was signed by ).,,.Richard Spitzer M.D. M.D.
Address 52....Park....St. Glens...Falls ,....N..v...... 12801
Place f Burial (orRemoval) .... .P,i..n.eujew...Ce.me.t.ery
(If bodyis to be temporarilyheld, (ill • space liter.)
CemeteryG�e�ls Fails, N,v. 12801 Date of Burial 4-5- 1974.
(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 James. eton. Tn.c 314 $av Rd. Glens Falls, N.Y,12801
-Name) ' (Address)
the F.uI'tis 'e .....D ....ect.QX' to hold temporarily and Tnt.e.X' the body
(Undertaker or person having charge of corse) (Inter, move, o other a di ose of (state how))
Dated 4-5— 19 74 (Signed)
ork. egtgtrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to an art of u.e 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
!C �` I< <( 4: / was ( i , 19 /
Date of ,,
(Interment or Cremation)/ .
iCf cL /G -
(Name of Cemetery, Crematorium, etc.)
(/1 , /( &/( ,
Section Lot No.. 'r -, Grave No. /
\--/(Signed) ii
(Person in Charge)
/ /
Address '` / / - - f y ( /f % (,
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 TH,REE (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.