Hall, Ella Form vs.(IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Local Registrar (Deputy or srbregistrar) 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. T-avrrr Registered No. .._...._........_
Village
Dist. No....1527.....County Essex .ciq, Ticonderoga
(If city, give street address)
Name of deceased...k:3.1a..H....Hall Veteran
Single, married, widowed, (If °` give name of War)
Sexk.emale...Color..ilhite or divorced (write the word)..:Y.doaed Date of Death June 18, 19. ..6 ..
Age al Years Months Days Birthplace Glens Falls, New Yq,;k
Cause of Death.BCi?Xle119prAe17tlIlQX.Ii.a.,...bi,late+s41,; cgrebral hemorrhage) arteriosclerotic 1ieart disease
Certificate was signed by Thgri.a.e..H...C.ilmiX1S M.D.
Address '.i.aA.rider ge..,...N.eW.XQxk
Place of Burial (or Removal)....TQWx1..PL.Cueetl§buxy,, New York
(If body Is to be temporarily held,fill in spece later)
Cemetery....k.zlzeYiel.. ;emet.eXT Date of Burial June 21, 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 he 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 Kirby D. wilcox Ticonderoga, New York
(Name) (Address)
the...thiert:diig r to hold temporarily and Later the body.
(Undertaker or person having charge of corpse) (Inter,•semove,or otherwise disoose of [state how])
Dated June 19., 1961 (Signed) 7,
Local Reg1at
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part;of the State (enbject to I'ca
3.
cemetery or other regulations), unless removal is by common carrier, is 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
‹:5727_________ . (--)
Date'of('21 "ace t 'l/r / 19 / /
( nterment or _
77
2
k �1/7t-f L r—it' l /' 1,C_f I t�7—
(Name of Cemetery, Crematorium, ote.)/
Section - Lot Nod 39. Grave No.
(Signed) /l e7 t t..�-z 7
(Person in charge)
Address / L �-t I�- l '.V �` L ,,
Person in charge must return this Permit tb;:
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.