Cavanaugh, William Form vs.eL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
zr 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 CERTI53 ATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._._...._...._....._._
198 Albany 113 Holland Ave., Albany, NY
Dist. No County orV City City
(If city, give street address)
Name of deceased William F. Cavanaugh Veteran Wr-11
Single, married, widowed, (If veteran. give name of Wax)
sex I,TaJ.e Colort"mite or divorced (write the word)Divorced Date of Death April 9 19 61
Age 61 Years Months Days Birthplace South Glens Falls,. la
Cause of Death Metastatic carcinoma of the ],4rynx
Certificate was signed by JQ('}l?,..J.,...G44>rxett M.D.
Address VA Hospital,, Albanys,,,
Place of Burial (or Removal) Glens Falls,, NY
(If body is to be temporarily held,fill in space later)
Cemetery St, Alphonse Cemetery Date of Burial 4/11/61 19
(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 Sullivan R. Minehan Parke St.,, Glens Falls,,,•J
(Name) (Address)
the Undertakers to hold tempos rily and I tex the body.
(Undertaker or person having charge of corpse) „44.7ter, move, otherA}ifse s [state how])
Dated 419/61 19 (Signed)...
Lo�al R
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the state (wrbject 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
PREMI SES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of was / / 19 (,/
(Interment or Cremation)
(Kale of Cemetery, Crematorium, etc.)
Section Lot No.lAj'� / Grave No. 11
'') tV it! I it n /)
(Signed)
(Person In charge)
Address 'Y G X 6
Z'
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 DIII CTOF- or UNDERTAKER MUST SIGN ABOVE STATE-
MENT, write across the face of the Permit the words
"No person in chjge," 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.