Wescott, Hermon Form vs.ell. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr This Permit can be signed only by the Local Registrar (Deputy or ■ubregistrar) 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
Dist. No ) 601 County Schenectady or City Schenectady
HERMON 0. WEES0OTT (It city, give street address)
Name of deceased Veteran
Sin le married widowed (If veteran, give name of War)
Sex Male Color White or divorced (wnte the word) Married Date of Death November 9, 19..5.9.
Age 51 Years Months Days Birthplace Town Ft. Ann, Wash. Co., N.Y.
Cause of Death Bacteremia from staphylococcus aureus organism due to postoperative infection.
Certificate was signed by E. J. Titzligibbon? M.D. M.D.
Address 1212 1fnion Street, Schenectady, Na Y.
Place of Burial (or Removal) Queensburyt Warren Co. ( Hudson Falls)
(If body I.to bi:Ifigory71Y held+8ll} aarldson Falls, N.Y. November
Cemetery i1�3 leW I.�IR �1l( Date of Burial 12, 19..51.
(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 )k•IEREBY GRANT A PERMIT
to Carleton Funeral Home inc. (Almon C. Wilson) Hudson Falls, New York
the undertaker (Name) to hold tempora ' and (eddre the body.
=nter
(U rtaker or pe n having char mr corpse) (I er remove rot erwt snore [state bow])
Dated November 19�y (Signed) ti
� Local Registrar
This Permit is sufficient for the Removal (and Interment or 'iemation) of a body to any part of the (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 of- C-.4 -1-31-1 was 2 ' 2.'19 (.)
(Interment or Cremation)
/22 42/C
(NaMe7of Cemetery, Crematorium, e tc.)
Section Lot No7\.5—k' Grave No.
(Signed) {- -
( rson in charge)
Address (i• -' 2-1 172_4
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-
RENT, write across the face of the Permit the i.ords
"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.