Harris, Charles Form vs.61 NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District ( own,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF� E OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No....,..._...LLLLL.,.,.. ..............
, .,. 4
Dist. No...SA57...County....................... zon, . In it x Queensburyrs NY
Charles J� Harris (If city,give street address)
Name of deceased Veteran No
(If veteran. give name of War)
Single, married, widowed,
Sex.M.ale, Color.16hite or divorced (write the word) Single Date of DeathNoventher 1Q 19.59..
Age Years Months Days BirthplaceTown..QUeenabur)..:Warren..Go.,.N.Y•
Cause of Death Third degree burns massive extent
Certificate was signed by....5. 11R1ax' F....HoR at M.D.
Address Clans. Falls y..NY
Place of Burial (or Removal) T.R19ti..A.i;..QueC2?S.btl'C'ys..III
(If body is to be temporarily held,fill In space later)
Cemetery Sgotddi Cemetery Date of Burial...N..QYg.141.,gx. .13 19.59..
(If body Is to be temporarily held,fill in apace later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to The Cadet=. FWn8rAl Honlfi.>, Ilia..._... HUtiNAD, Fa1a0.,..J.Y
(Name) (Address)
the Undertaker to hold temporly and Inter "2 Y'x rr the body.
(UnAertaker o person having charge corpse) (Inter,remov ee d„ianose of[state)how])
o l2 `-
Dated 4 s 19....2. (Signed) .-!.:r� z_ ,: zt:Z.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Slate (,abject to local
cemetery or other regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PRISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE Cin&I2
Date cW J- w&/'7'3::,-J . 19interment"or(
4
(Name of Cemetery, Crematorium, eta.)
Section Lot No. Grave No.``'
(Signed) ,' .
;
(Person in charge)
Address7"---- t �. �-- -+ /
Person in charge rust 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 UNDERTAKER MUST SIGN ABOVE STATE-
MENT, 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 re—
quired, under penalty, to report violations thereof.