Dion, Edward Form VS.SL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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 p{CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No—(y...l Village . ---
Dist. No 5601 County Warren or City Glens ails Hospita$
(If city, give street address)
Name of deceased Edward H Dion Veteran no
Sin le married widowed (If veteran, give name of War)
Sex Male Color White or divorced (write the word) Married Date of Death May 214 19...6
Age 8? Years 6 Months Zi....»...Days Birthplace Pur1in tt..on..Yermont,
Cause of Death CQx.Cnary GCGLMall
Certificate was signed byw4ttiri.. CmbBx M.D.
Address..3z Pearl treet udson , alls Nay.
Place of Burial (or Removal) Ts7F121..QueeXaux7 worren co....N..Y•
(If body is to be temporarily held,All in space later)
Cemetery P.ine.yz ew Date of Burial May 26 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
Number, and on the basis thereof I HEREBY GRANT A PERMIT
t6xl et.on.. :uzzer.al..home Irac.•(A..C.l il.s cta l............ Huds on Falls N!y•
(Name) (Address)
the Funeral, D rectq to hold temporarily and Ipte ' the body.
nderta r or person having charge corpse) (Inter, move,or otherwise dispose of[slats howl)
Dated ay 2, 19 02 (Signed) :j.c--�'-�—r -`:%
Local Registrar ,.
This Permit is sufficient for the Removal (and Interment or Cremation) of a to any pert of the State (.abject to local
cemetery 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 of f 'wc t19
(In "vent or
e� {
.0-'------2.4.1....€ (Name of Cemetery, Crematorium, etc.)
Section Lot No.11J`-61 Grave No.
L____..-j?% 71 -. '
(Si fined)
..7.7;,"-.---40&
"son in charge)
Address +�----- -
Person ' arge oust return this Permit to3/
the Registrar of his District within SEVEN (7) D cS
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.