Ball Sr, Owen NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tg" This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Vilrage, 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, Village Registered No. 4
Dist. No. 4562 County Saratoga or City Town of Moreau
(If city, give street address)
Name of deceased Owen L. Ball Sr. Veteran No
(If veteran, give name of War)
male Single, married, widowed, `,arried April 7 76
Sex or divorced (write the word) Date of Death 19
Age 57 Years Months Days Birthplace
1�ork State
Cause of Death Myocardial infarction, acute ASCVDy
Certificate was signed by Robert A. Reid
M.D.
Address Harrison Avenue, Glens 'Pills, New York
Place of Burial (or Removal) West glens Falls, New York (Townof 'Queensbury)
(If body is to be to ora it he d, (ill, i act later)
Cemetery mWest dens r a`il�s cemetery Date of Burial April 10 19 76
(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
PERMIT
to Clark Funeral Home (Donald L. Clark) 136 Main Street, South Glens Palls, N.Y.
(Name) (Address)
the undertaker to hold temporarily and inter the body
(Undertaker or person having l charge of corpse) Inter remove, or the tse dispose of (state how))
Dated April9 bb (Signed) �� 144 , ... . k1 t Gx� 'J
Local Registfar
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. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON VIHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of<9
��1' ' '�`�was .11, e 19 /‘
(Interment or Ct��nudttZ.�
4)_Azi 1tires .
(Name of Cemete y, etc.)
Section Lot No. Grave No.
(Signed) L�( -
(Person in Charge)
Address ,(f--717
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.