Harrington, Leslie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar 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. 35
Town, Village Registered No.
Dist. No. 5601 County Warren or City Glens Falls
(If city, give street address)
Name of deceased Leslie E. Harrington Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Single Date of Death 10/1.3/76 19
Age 79 Years .Months Days Birthplace NY
Cause of Death Sudden Death Svnd. Associated with Coronary Atherosdierosis
Certificate was signed by S. Richard Spitzer M.D.
Address 90 South St. , Glens Falls, NY
Place of Burial (or Removal �tTown of Queensbury 1, NY
f b is twestmtfen'sh ails°CsemeterS 10 16 76
Cemetery }� Date of Burial / / 19
(If body is to he temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same Appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERM T
to Carleton Funeral Home, Tnc., Main St. , Hudson Falls, NY
(Name) (Address)
the C. Bruce Wetmore to hold temporarily and Inter the body
Dated(Undertaker person having charge 19 oof�oorpse) (Inter, remove, or otherwise dispose of (state how))
(Signed) 1..l .0-3\4.\( .N.��A..F—\
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.
FORM VS. 61. (1tEV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date ofw was 61-C--1 / '19 76
(Interment or Ccamatr�onl
(Name of Cemetery,
Section Lot No. Grave No.
(Signe
(Person in Charge)
Address 16 Y O
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 DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, 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 required, under
penalty, to report violations thereof.