Pesez, Albertine Form VS.EL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
s: 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._ .._.. :...._._
5726V
Washin--ton or City Hudson Falls
Dist. NoCounty._.........».. � City
(If city, give street address)
Name of deceased Alber tine M. Pesez Veteran ;IQ
Single, married, widowed, (If veteran. give name of War)
Sex Female Color'' -te or divorced (wte the wrd) Widowed Date of Death January 3.,. 19. 61
Age 89 Years Months Days Birthplace Rouen* France
Cause of Death Pul mon*ry ide iaa
Certificate was signed by W i iaim Sf2. John M.D.
Address Glens alls, N.Y.
Place of Burial (or Removal) Twit...SIf...Q,Ate 3b.11.17.
(If body is to be teWp9rartls phe L ld.BlUuin�space later) Jitn
Cemetery Date of Burial 1r 7, 19 61
(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 SATISFAC!'ORY 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 Glens Falls N.Yto Sullivyt�,.. . I! l.ilri.hii.1�► t •
(Name) (Address)
under taker the body.
the to hold temporanl r� int,ar., r y
(gndertaker orj,rson having charge°Rope) ... r %(Inter, remove et of fed ` (state]"
Dated anuary 19 (Signed) .. ` � ' ) :/-s- ,/
i,epilty i«alegitra This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (.abject 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 wasC7 T44't'' 11, 19 (C) '
(Intersent t oa..GCEa�jypy
(Nese of C et , Creme rims, etc.)
1/i-o PX/6r4071
Sal
Section Lot No. Grave No.
(Signed) A1 i A • ` a��✓"
(Person in charg )
/�
Address �9 V V
P-a-042M/
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-
MENT, 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.