Crandall, Elwin MEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rir 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. 310
Town, Vill Registered No.
Dist. No. 198 County Albany or City 3 Holland Avenue, Albany,,,....�Ig�.i.Qxi.
(If city, give street address)
Name of deceased Elwin E. Crandall Veteran JAI...2
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) ...Widow.ed Date of Death 8-24 19 75
Age 71 Years Months Days Birthplace New York
Cause of Death Bronchogenic carcinoma,left lower lobe primary,with widespread
Certificate was signed by John A. O'Hern metastases M.D.
Address VA Hospital, Albany, New York
Place of Burial (or Removal) .... . . TOWn of QueeAsbu. y,.., New....Xork
(If body is to be temporarily h d, (ill in space later)
Cemetery west Glens Falls Date of Burial a/27175
(If body is to he temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same a,ppearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT Densmore Funeral Home Corinth, New York
toundertaker e) Inter( ddress)
the to hold tempo ' dthe body
(Undertaker or person havingS p e of cowge) (Inter, remoivy,, or Ise disp%se of state how))
Dated /G 19 1 (Signed .gIC /...V7-
ocal Registrar
This Permit is sufficient for the Removal (and Interment or Cre tion of a bo any part of the State (subject al cemetery or
other regulations), unless removal is by common carrier, in which case Transit Permit(VS No. 62) is required.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date o df'was �� �9�—�
(Interment o )
(Name of Cemetery, ertinam, etc.)
Section Lot No. Grave No.
(Signe
( erson i Charge)
Address �l / /
Person in charge must ret m 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 UNDER-
TAKER MUST SIGN ABOVE STATEMENT, 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 DIECTORS and UNDERTAKERS
violating the law relative to fhbreturn 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 required, under
penalty, to report violations thereof.
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