Harris, Janet Form VS.si NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir 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 CERTIFI '.4' OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._..`-.-J _._.__
Dist. No..5657 County...74 :I:on .�,4'0'`14: Queensbury, NY
(If city,give street address)
Name of deceased Janet A. Harris Veteran No
Single, married, widowed (If veteran. give name of War)
Sex Fern Color �tllifi'e or divorced (wte the word) Married Date of Death November 10 19 59
Age 24 Years 7 Months 7.5.............Days Birthplace T9W..Qf...RtuggR0 7.41 ." NI
Cause of Death...T.b,ird..Deg:ee...baX:ila4..lAtli'3.gi.Ye..xtertt
Certificate was signed by Sg.Y.11t.4.l ' Fa Hopfan M.D
Address Glena... :alls..N.Ya
Place of Burial (or Removal) Tcywn of Queensbury, NY
(If body is to be temporarily held 81LSn space later)
Cemetery �Scotcl� uemetery Date of Burial November 13 19 59
(If body is to be temporarily held,fill in space 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 Mt Ca 1 4.B FII-nArg Home, Inc. uudson Falls, NI
(Name) (Address)
the Undertaker to hold temporaril and inter the body.
(IICIertaker r rson having charge gyAorpee) `(Inter,remove,orcelh 1pise @ts*fo a of[state bow])
Dated NOV* .i. 19 77 (Signed) .�t( ' r .7-- --r:.):2c::`
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part 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 S1;X`LUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE cfri.,7 cjte7i.
Date of was``'� '�" ;-
19 i
(Interment or Cremet an)
(Name o Cemetery, Crematorium, ete,)
Section �. Lot No. Grave No.
if
(signed) +
Person in ehirg
Address Yi ;;;;F—
Ad1
Person in charge mast return this Permit to
the Registrar of his District within SEVEN (7) DAYS
from above dam. If no person is in charge, the
FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the wards
"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.
I'he law will be enforced. Local Registrars are re-
quired, under penalty, to report violation thereof.