LaCarte, Theresa Form VS.EL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or This Permit can ha 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. _ Registered No.
agillage
Dist No...5 .Q1....count, Warren or City G1,ens..k'.a1.7.s...1-Iasrsi,t•al
(If city, give street address)
Name of deceased T.heresa.Anne...IaGarte Veteran no
Single, married, widowed, (If veteran, give name of War)
Seiemale Color .hits or divorced (write the word) .5ingl.e Date of Deatharch...8 1941.
Age 0 Years U Months 5.»...Days Birthplace..2l,ens••-ea11s.. i.Y•.
Cause of Death AtteleG.tOS1S.0. Px matmri.ty
•
Certificate was signed by Fr. 17.C.3,S DeveX M.D.
Address U4? "1a3:X't'U. btreet Glew Pall,,g NAY.
Place of Burial (or Removal Town...Queexisbury i'arren..G.o.•.N.Y.
(If body is to be temporarily held,fill in space later)
Cemetery St.AlI?h.9.IPM§ Date of Burial MaX Ch....10 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 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.c.riet.on....uner.al Home. .Ine.. (A.C...Wils.on.).. Hudson.Falls...N.Y.
Underta er (Name) (Address)
the to hold temporarily and Inter the body.
(Undertaker or person having charge of corpse) (Inter,remove,or otherwise disnoee of [state how])
Dated March...10...1961 19 (Signed) Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the 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
Date of X!Yl�:. Lam,. _ was / i /0 19 6 ,
(Interment or Cremation)
In
(Name of Cemetery, Crematorium, �etc.)
d,
/1214.4-7/7
Section LQt No. Grave No.
(Signed) 1/4-4-1/
(Person in charge)
Address
,-
Person in charge mist 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 OF'FliNSE.
The law will be enforced. Local Registrars are re—
quired, under penalty, to report violations thereof.