Whaley, James .lam as.al. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir 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.
Dist. No.$255 County..... b pxi or-City Village Unian..Cemetery vault.
(If city, give street address)
Name of deceased James Henry Whaley Veteran .... a
(If veteran, give name of War)
Single, married, widowed,
SexMal,e Color..v. ..trg or divorced (write the word)....M..arr.i.ed Date of Death Feb,...13 1962
Age 63. Years 3 Months 2.1..._...Days BirthplaceQlefS Falls iu•,y•
Cause of Death (rax,Citliix.y...QCALUSian.
Certificate was signed by.l?it toia..Qx:eenLer.g M.D.
Address.Elra.S.l;i.5$.r.e.t .. 1,lt ol1 Faz1A..N.Y.
Place of Burial (or Removal) `raYna.MUDNI A ..Queensbury Warren Co.. .N..
(If body la to be temporarily held,fill In space later) Aptil , '62
Cemetery X,..Firaevd. Date of Burial.�j N.. 19..62.
(If body I.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
td,arllt an Fuxteral...H0me...lue.(A..C.AnI. MIL....._... . cad on..r ails 1v.Y..
(Name) (Address)
th€Funeral Director to hold temporarily and Inter the body.
(ilndertaker or person haying cbargepfr corpse) (-'`"‘ . ( nter,remor or p9at rise dispose of[state bow])
Dated A41'1.a. I..0 19...4?? \
. (Signed) ",�fr K.-. tr"t.... i , l ct.... ..in---_
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pert 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.
INDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTS OR CREMATIONS
ARE MADE
Date o iJz--�, w /
(Inte nt o
/'2 73/ ,
(Name of Cemetery, Crean torins, etc.)
4441-1-1." r(-1P---1-a-cs--4:?----,
Section Lot No. j ?(:Grave No. �
(Signed)
:7'
(Person in charge)
Address
Person in charge must return this Permit tok 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 ONWaNSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.