Twiss, Lena Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Ca 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._
/4124 Rensselaer Village Castleton—an—Hudson
Dist. No County or City
(If city, give street address)
Name of deceased Sena wigs Veteran No.
Single, married, widowed, (If '""'"' give name of War)
Sex - • Color i�`W. or divorced (write the word) single Date of Death 11�2/w_ 19
Age Years 8 Months 14....».....Days Birthplace Luzerne, 1:\I.Y.
Cause of Death ti:gQca.r:di.ai....Inf 5.ro.t,ism
Certificate was signed by JQb.II l`l,...5isir. .... M.D.
Address RD##1, Cast let onA N.Y.
Place of Burial (or Removal) Glens Falls, New York
(If body la to be temporarily held,fill in space later) ,
Cemetery ins V l�'�� Date of Burial li-2� 1952
(If body le to be temporarily held, fill in space later)
Thi 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 John J. Ray for Ray Funeral Service Inc. 19 Ransom Ave. ,Ca.stleton1 NrY.
Undertake ame) , in (eddreee)
the to hold temporard and the body.
(Undertaker or person haring charge o2 corpae) (Inter,remove,or otherwise die [(6tate how])
Dated Aove-r er 2,/ 19 (Signed) t�~``" —'
Local Registras`"—
Thu Permit is sufficient for the Removal (and Interment or Cremation) of a body to any pait 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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
i
Date of C' -,., ../ir/! i 19_e 4
- (Inte nt or Cre'ma Son)
,/� ./) /
'
J Z."
U i4.�t-L -z..� ' 2,
(Name of Cemetery, Crematorium, etc.)
Section --N fl_„"- Lot Nov' I '5 Grave No. /
t
io(L r
(Signed) '--1-. , ,`. �Y>-7t (
�E.
(Person in charge)
Address 6; ac 76 t'/L.(; _.- °.: t.i_. v=�/- -,
Person in charge Waist 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.