Harris, Charles P (2) Form vs.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 CERTIFIC TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. liaiiiX Registered No. _.._.. L..`�
Dist. No....5'R3.....County Warren oar City Glens Falls, N.Y.
(If city,give street address)
Name of deceased Charles P. Harris Veteran NO
(If veteran, rive name of War)
Single, married, widowed,
Sex Ma1e...Colalite or divorced (wnte the word) d m.t.arx:i Date of Death...liov er..•14 19 59
Age 25 Years 3 Months .....Days Birthplace TOtm of QlItP.00 Uz'x....NI
Cause of Death....Tla.3.rd..Degree...burne-reuse ve. eactent.
Certificate was signed by ey.CUlaur..F.....ERp an M.D.
Address Czl.exls..k al.ls.r..hlY
Place of Burial (or Removal) TOW13...Sf QxzeAY)>grury
(If body is to be temporarily held,All in space later)
Cemetery Scotch (. meteliy Date of Burial ye(ol Z'...7.3 19....59
(If body is to be temporarily held,All in apace later)
Thu 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 Uarleton Funeral Home a Inc? Hudson Fans;,,.,
(Name) (Address)
the Undertaker to hold temporarily and i .,... the body.
(Undertaker or person having charge of corpse) (Inter,remo or rwi [state howl)
Dated NAv....12 19 59 (Signed) .... N .. ..
Local Registrar
This Permit is sufficient for the Removal (and Interment a Cremation) a y to any part of the State (sub' 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
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE 0,6,662_,‘ (2 ,
Date O 44
�...... away - (J /9 i9v7
(Interment or.C`ypstion)
V/e.el-re.1: ., L.--.V.C-14,e-.fe-' - "
/
(Name of Cemetery, Crematorium, etc.)
Section ___ Lot No. Grave No.
(Signed) G ,= '4-„ - '�.'c-- G 4 x
(Person in charge)
s `'
Address L X 0 r
Person in charge mist 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.
i