Mead, Timothy 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,
Vill'age, 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.
,----:::7 ),-) / Washington Town, Village Registered No.
Dist. No.-) ' ••,,--L---7' County -- or City Hudson Falls
(If city, give street address)
Timothy John Mead No
Name of deceased Veteran
(If veteran, give name of War)
Male Single, married, widowed,
Sex or divorced (write the word) c inn le Date of Death 8/29/75 19
Age - Years .Months Days Birthplace
Cause of Death Asphyxiation
Certificate was signed by Dr. Milton Greenberg M.D.
Address 32 Pearl St., Hudson Falls, NY
Place of Burial (or Removal) . Town of Queensbury, NY
(If body is to e.,temporarily held,•iiir in space later)
Cemetery rineView Cemetery Date of Burial 9/2/75 19
(If body is CO 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 Appearing 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
to
Carleton Funeral Home, Inc. , Main St. , Hudson Falls, NY
(Name) (Address)
the C. Bruce Wet ire to hold temporarily an Inter the body
(Undker or persoitt having charge ofArse) tfr-ig remove, or.;:e etiffpol (state how))
Dated •! ' . . :tt.,7- ••,.,--1,,. 197 144 (Signed) „...Zed"----/-40' • --r,...4.
Locr..Registrar
This Permi is sufficient for the Removal (and Interment or Cremation)of a body to any part of t.,c 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.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
r
Date of i ft-GiJ was 2 19 7 s~—
(Interment or Ctt rtraricr4.�
,z,,.......);_e
(Name of Cemetery, Czeourtatil0. , etc.)
Section 7 Lot No. / / i Grave No. 7
(Signed) Ill `t
ie=2, ,.7
(Person in Charge)
/2,6tc,- /-2,e
Address /
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 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 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 required, under
penalty, to report violations thereof.