Watson, Lois Form vs.si. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
s: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....
5762 Washington Vibe
Dist. No County or.Gi gilkg.gl? .Y
(If city, give street address)
Name of deceased 'Lois S. Watson Veteran No
(If veteran, give name of War)
N'eirale White Single, married, widowed, MarriedJune 3, 62
Sea' Color or divorced (write the word) Date of D ath 19
Age....56 Years Months Da s Birthplace DePeys ter, N.Y.
Cause of Death Multiple severe lacerations of Brain
Certificate was si ed by... John I. McCann, CoronerYs Physician for Leslie white M.D.
Address 'ids On -rails, .7.
Place of Burial (or Removal) Town of aueensbury, N.Y.
(If body Is to be tem oraril eld,fillin space later)
Cemetery line View Cem. Date of Burial June Sa 19 62
(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
Kumber,�nd on th basis thereof I HEREBY GRANT A PERMIT r� • N.Y
o egan 8: Denny ne. Glens ails
(Name) (Address)
h under eta,ker to hold tempos ' y and inter nowj the body.
(Undertaker person having charge ce/orpse) (Inter,remove,
Dated o U-e c, 19 (Signed)... . ernit "
T... Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pant of the State (subject to local
:amatory or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSE ENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date o F� /� was `� 19
(Intercom or
(lane of Cemetery, Crenatoriu., etc.)
Section Loto �Ai Grave No.
(Sued) l !
(person in charge)
Address
Person in charge oust 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.