Phelps, Walter Form vs.al. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
la 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. Town Registered No.__..430 _
Village
Dist. No 198 County Albany or City 113 Ho11,4X1d,,.4v.e". ,Atbany.,...NY
(If city, give street address)
Name of deceased Walter G. Phelps Veteran WW1
(If veteran, give name of war)
Single, married, widowed,
Sex..lvl.d),P Color T.-IIlite or divorced (wnte the word)...N tx.i.tY4 Date of Death .1.2/..111.61 19
Age 64 Years Months Days Birthplace Lake George,.....1 X
Cause of Death Congestive Heart Disease
Certificate was signed by Irwin I. Spritzer M.D.
Address VA Hospital, Albanyy,.,. y
Place of Burial (or Removal) xaTa.1..Qf...Q;U,ee,'1P 111C7, 'Jeer YO rk
(If body le to be temporarily held,fill in space later)
Cemetery ?.1-Y:E CFS!lg: en�- Date of Burial 12/14 19 61
(If body Is to be temporarily held,fill in space later)
Th4 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 M.W. Kilmer Funeral Home Argyle, NY
(Name) (Address)
the Undel;talc x to hold tem••ra 'ly and ter. the body.
(Undertakes p1per3op having charge of corpse) ` / Inter remor ,or o -rse of[state how])
Dated 11L/ 1�61 19 (Signed)....' Q ep
I.�cal R- ,
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of I.. 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 SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
'^i _
Date of:421.(r wasc'''C_• / 19
(
(Interment or Creation)
..,...4) --5Z
..e-?.../C: C.:;--vZ11-<"
(Myth Cemetery, Crematorium`,, etc.) k.
Section Lot No. Grave No.
(Signed)7, '2V/A-A-7-:---- (/�•f 7 t 4-
(Person in charge)
Address //77 7/5,4, ,c1�`` l�t --' `C4 , .sue/z: %?7,
Person in charge must return this Permit to
the Registrar of his District within SEVEN (7) BAYS
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 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 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.