Nobles, Charles Form vs IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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.... 129
Dist. No County
198Albany or VillaCityge Holland 113 Avenue, Albany, New York
(If city, give street address)
Name of deceased Charles A. Nobles Veteran WW II
Of veteran, give name of War)
Single, married, widowed,
SexMaLe Color...JfZbjte..or divorced (write the word) Married Date of Death 4/7 19 61
Age 45 Years Months Days Birthplace Glens Falls, New York
Cause of Death Riaht ventricular hypertrophy and dilatation
Certificate was signed by Theodore S. Beecher M.D.
Address Y.....4.....I14nkital,, Albany,, New York
Place of Burial (or Removal) GUKIA.. a.1.J.s.,..l`Iew..Yo.r.k
(If body is to be temporarily held,fili in space later)
Cemetery St, Al.phonsus Cemetery Date of Burial 4/10 19 61
(If body is to be temporarily held,till in space later)
Thy 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 Potter Funeral $gry c& 136 Warren Slere ,. .Glens...F.al.l,s.,...I'lew..Yark
Undertaker (Name) (Address)
�ril and , Inter the to hold tempor the body.
(Undertaker or person having charge of corpse) A (I ter, " ore,or gtberwise dlrose of[state bow])
Dated 4a.7 19...61, (Signed) .. d. -
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (eabject 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 was 19 �' 1
(Interment or Cremation)
(Naas of Cemetery, Crematorium, ete.)
A
Section Lot No. •�`-3 Grave No.
fr
(Signed)
(Person in charge)
Address
Person in charge iiust 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.