Burnett, Martha Form VS.Sl NEW YORK STATE DEPARTMENT OF AHEALTH
OFFICIAL BURIAL (OR REMOVAL) ,PERMIT
sar 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 R __._:
Village Dist. No County Saratoga or City Town of l'ioreau
(If city, give street address)
Name of deceased artha Burnett Veteran
(If veteran, give name of War
Single, married, widowed,
Sex felnaleColor 'thite or divorced (wnte the word) Date of Death 12 19th 19 62
Age ?9 Years Months Days Birthplace 'TT&..XRrk...tate
Cause of Death C• J. A.
Certificate was signed by .Bet.ty...Ir....V.nelkgr M.D.
Address 15 Ride Street4Glens 2 allsAl(. Y.
Place of Burial (or Removal) Town of ueensburyA"'. Y•
(If body is to be temporarily held,fill in space later)
Cemetery Pine "ievr --etery Date of Burial 1Q 2Z 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
to ii- gr i....rii Le.1:::y....... .. "lens rails,' , •
(Name) (Address)
the undertaker to hold temporarily)and i.it r the body.
(Undertaker or person having charge of corpse) n move,or,otherwise dispose of[state how))
Dated..lV. f.Q 12 19 (Signed) ... ' _ 4
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 INTERMENTS OR CREATIONS
ARE MADE
Date of was ��F_'t.. L'Z 19 ', 7_'`
(Interment or Cremation)
J C1.-e
(Name of Cemetery, Crematorium, etc.)
// s---/ ..-(..„.c"*"...- L",.........k,.-
_y Section � Lot No. '' Grave No.�2-7
(Signed mil- 0i z - t\. /e' l/ i
(Person in charge)
Address � 'r t-'L ,KZ "ti'ti---„
Person in charge Heist 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.