Hunt, Mary Form VS.Si. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ra• 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 CERTIFI ATEOF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. ---Town.--- Registered No.-....9cS',j_ ....
V-ill-age
Dist. No.. .6QJ. County Via lren or City Cielaa Fa..13.5..Nl1gl.ta1
(If city, give street address)
Name of deceased iiARY AGNES NIJNT Veteran -tio
Single, married, widowed, (If veteran, give nameof War)
Sex Color =riti?...or divorced (wnte the word) -ArI:7.gd Date of Death..ay.....14i. 19. :2...
Age Years 11 Months 8 Days Birthplace Rutland Vermont
Cause of Death caarclia.l..ii131t]Jx e.,..:lY.p car.di.a7...I.nf.a,T ct ..an.,
Certificate was signed by Frilax:f .a.aE.e±.? M.D.
Address 9..`hermazl Ave.Glens. Fails N..L,
Place of Burial (or RemovalT : n.. aeens:ous:y Warren Co N.Y.
(If body is to be temporarily held,till in space later)
Cemetery Basle:.i.e , Date of Burial T,Tray. 19
(If body is to be temporarily held,till in space later)
Thu 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
torarlctgn Funer?l RomP Tric, (A ", ilson). Niidson Falls N.Y.
(Name) (Address)
the F"ineral Direct^r to hold temporarily and I r the body.
(Undertaker or person having charge of corpse) (after,r el go-Uipr l'nose of [state how])
Dated....;.:u.. 19 (Signed) 99 f{
Local Registrar
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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTEITS OR CREMATIONS
ARE MADE
Date `'y i.tt�j t . }L—
( tef�sat ar Cremat m)
• (211
(Name of CemeLeTy, Creme torium, etc.)
Section Lot No. // Grave No.
(Signed)
(person 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 DIRECTOF 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.