Irwin, Leslie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tgr This Permit can be signed only by the Local Registrar (Deputy or subregistrar)of the Primary Registration District (Tonn,
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. C�7/
Town, Villa Registered No.
Dist. No. 5601 County Warren or City ens Falls
(If city, give street address)
Name of deceased Leslie Clarence Irwin Veteran No
(If veteran, give name of War)
Male Single, married, widowed, Widower 11/23/75
Sex or divorced(write the word) Date of Death 19
Age 78 Yea Months . .... Days Birthplace NV
Cause of Death
Certificate was signed by Dr. Joseph Feingold M.D.
Addresa2 Fast St., Ft. Edward, NY
Place of Burial (or Removal) Town of Queensbury, NY
(If body is to be temporarilyhe d iill in space later)
CemeteryPineview Cemetery Date of Burial 11/25/75 19
(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 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 Wetmore to hold temporarily and Inter the body
(Underta r person having charge of core (I e , remove, or otherwise dispose of (state how))
Dated �- ps
ti--„ -. 19 75 (Signed)
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to y part of the State su ect to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit(VS No. 62) is required.
F'OltM ITS. 61. (ItEV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of i Z141 1-sf1tt--7‘" was /141.2% S Ig 7S�
(Interment 6i Ct.emar n.)
(Name of e ',
i el
Section Lot No. OP C-Grave No.
(Signed) Wt.
(Person in Charge)
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.
•w�
SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable tQ.A,
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.