Vaughn, Alida •
N..
Perm v&sI. 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,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATF OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No—.
Dist. No.1 :� Couaty...8a.ahingtxtll7: Ft. Edward N.Y.
(If city, give street address)
Name of deceased A,lida.Matbilds. Vaugbn Veteran No
(IF veteran, give name of War)
Single, married, widowed,
Sex Fes...Color it. or divorced (wnte the word). :Widow Date of Death....Sept.••22y, 19..9.•
Age 83 Years Months Days Birthplace St9CkbGas...01txden.
Cause of Death Cerrebraal..Hemorrxbrage
Certificate was signed by Miitan.. ....Greenberg M.D.
Address Hudson FallsP NY
Place of Burial (or Removal) Tcum...Queensbury.,..NY �+
(If body Is to be tempsrari) held,fill in space later) 25 1979
CemeteryDate of Burial Sept. : 19
(If body is to be temporarily held,fill in space 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 CIPX9APAI FLU-Aral Hq , Ipp.e Hudson Falls, NY
(Name) (Address)
the undertaker to hold temporarily and iXt.I' the body.
(Undertaker or person having charge of corpse) \�r , (Inter,remove,or other dispose of(state bow])
Dated S,ep ember...23 19..59.. (Signed) . .. .0...2..sh..,:,.......r .; -1 !.•i.::Z...l,, ._- _ c
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State bj.ct 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 I YDi'+„ID TS OR CREMATIONS
ARE M. aE
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Date of 19
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(Inter at or remati
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(Na of Cemetery, roma tartan, e tc.)
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Section Lot1No. Grave Nu.
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'� (Parma* in s*rip)
Address éctAcZ& '„'k ' ,1 a
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) OATS
fran above date. If no peraoti is in charge, the
FUNERAL DIRECTOR or UNDERTA 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 islocated.
SEXTONS, FUNEi(A DIFEQTORS and UNDERTAKERS
violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOLLARS
NOR MARE THAN FIFTY DOI,LAR.� FOR THE FIRST Or'r1.NSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.
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