Townsend, William Form Fs.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ur 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. .........._
Vill
Dist. No 1301 count, County or City
Dutchess
(If city, give street address)
Name of deceased William A. Townsend Veteran No
Single, married, widowed, (If veteran, give name of War)
Sex M Color W or divorced (write the word) Single Date of Death Aug. 10,, 19 6�
Age 78 Years Months Days Birthplace New York
Cause of Death Myocardial infarction
Certificate was signed by Paul C, Gare7,l M.D.
Address 50 Fishkill Ave., BeaQcm„ N,Y,
Place of Burial (or Removal) Glens Falls., N.Y.
(If body 1s to bp? neviewe1 emeteryer) Aug.
Cemetery Date of Burial16, 19 6 .
(If body is to be temporarily held,fill in space later)
This 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 Thomas C. Varland Beacon,....N„J.,
gt( ms) (Address)
the UIdexta er to hold temporarily and Inter the body.
(Undertaker or person having charge of corpse) (Inter,remo e,or otherwle dimose of(state bow])
Dated . Aug., .11.E 19 61. (Signed).... . . —yt_-c,<i -L
- Deputy c 1 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 CRBIATIONS
ARE MADE
Date of /.�1� -, I was ! _19 (
(Interment or Cr " tion)/
),„/t tt 77-1/Viae \ J !yr �.�' •
(Name or Cemetery, Crematorium, etc.)
Section Lot No. l Grave No. y
(Signed) ,/l/it'll-��- ��7 2/6
(Person in charg
.),S1
Address
Person in ch,3rgce Heist 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 OFFiNSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.