Harris, George Borne VS.sL 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 (lawn,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF)C TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.__.._...._...._.._
Dist No....5657....County Warren Queensbur7 NY
(If city, give street address)
Name of deceased George L. Farris Veteran No
(If veteran. five name of War)
Single, married, widowed,
Sex MAIM. Color W)ite..or divorced (write the word) 5ingl.e Date of Death...A o uL1 r..10. 19 59
Age 2 Years "Months 7 Days Birthplace Glens Falls, II
Cause of Death Third degree burns massive extent
Certificate was signed by Cy.n ur F. Nap.#:an.... M.D.
Address. Glens Falls,, NY
Place of Burial (or Removal) TPIM...4.f...QuqIlsJ'1117s...5`
(If body Is to be temporarily held,fill In space later)
Cemetery SCgta,_Ce ,e rery Date of Burial IIo ail:ex.13 19..59.
(If body Is to be temporarily held,fill in space Iater)
Tho 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
Nu n the basis thereof I HEREBY GRANT A PERMIT
to T116 and Funeral Homef Inc. Hudson Falls, NY
(Name) (Address)
the UndtrtAkAr to hold temporarily and Inter the body.
(Undertaker or non having charge gfre �
orpse) - (Inter,remote, atlierwI disnose of[state bow))
Dated Nov. 12 19 7 (Signed) y (
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pert of the 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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date i� 2 %� -'tress ig .5-7
(Interment or
t
._.., : :e--14— ' /
(Name of Cemetery, Creme forlorn, etc.)
Section Lot No.* Grave No
i c
2
.-
(Signed)` ,,'"r "�C6,�,z (c,
(Person in charge)
l C_. n
Address G' G -'l '� t�.iZ--Z ki y
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 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.