Guyette, Maude Berm V8.a. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr This PsVIZIat 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No—
Village
901 CLI NTON Village PLATTSBURGH
Dist. No Countyor City
(If city, give street address)
Name of deceased MR S.MAU DE GU YET TE Veteran r`=-o
Single, married, widowed, (If veteran, give name of War)
F W WI DOWED MAY 24 59
Sex Color or divorced (write the word) Date of Death 19
Age 63 Years 8
Cause of Death CHRONIC LMoT FIAtiC teatMI A
Certificate was signed by GORG H. GO V A M.D.
Address PLATTSBURGH,N.Y, ,
Place of Burial (or Removal) GLENS FALLS, N.Y.
(If body is to be temporarijt jteld,Al).}p,�p�ce later)CEM.
Cemetery .ML t'�-(U SUS Date of Burial MAY 27 19 59
(If body is to be temporarily held,811 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 1.a5...CLA.RK.,..t.AlC...sY...AIIRE.L...E.A,RS4.NS IrtiAM.P..I.A.t.N.,.N...Y..
UNDERTV I NT R (Address)
the to hold temporaril nd. the body.
(underiq o2uerson having charge gi .. .Aorpse) (Inter,re e, therwi lsno a of(state bow])
Dated �M{{�� 19 (Signed).. . ... . - ,4Q....
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 SEVION OR PER9DN IN CHARGE OF
P1FMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of,2.`{ '` e.-,- rows 7 1947
(Interment or:Cremation)
(Name of Ceme ry, Crematorium, etc.)
k i
Section Lot No. ° Grave No.
(Signed)
(Person 1l Large)
.3 d. 0 --
Address 6 f�� ~^� �•
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 DIRECTOF 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 TITAN FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, Jo report violations thereof.