Primeau, Elmer form VS.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tT 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._ -`` _....
4562 Sarato a Village Town of Moreau
Dist. No County.... ........ or City
(If city, give street address)
Elmer J. Primeau r_o
Name of deceased Veteran
Single, married, widowed, (If veteran, give name of Wax)
Sex Male Color W ite or divorced (write the word) '`'arried Date of Death 12/24.62 19
Age 74 Years Months Days Birthplace Rouse Paint N.Y.
Cause of Death Myocardial Infraction,. Generalyid Aleroscelions
Certificate was signed by 'William U. St. John Glens Falls, N.Y. M.D.
Address 153 Bay Street,, Glens Falls, New York
Place of Burial (or Removal) inter
(If body is to be temporarily held,fill in space later)
Cemetery 4. i rl:PiI.9Xl Mh C`= "1ete>;<' Date of Burial Dec. 48a 196g 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 SIAni .s...x'..... i..r. :a;.ts: -ien.s Fallg,, N .y. G 8„U
(Name) (Address)
the Un.der.taker to hold temporarily and inter the body.
(Undertaker or person baring charge of corpse) (1121,er, remove„dor othsraWdisooae of(state ow))
Dated Dg. Ibex 2.., 19.. .u.. (Signed) ' 4. ..r, •.. tZ:G:� G4:
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pant of the State (s tbject 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 SEX IUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of2 was 19
(Interment or Cremation)
(Name of Cemetery, Crematorium, etc.)
Section Q"' jr. Lot No. 6 4^ . t Grave No.
(Signed) ( � i
(Per on in charge)
Address
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 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.