Gould, Leonard -_roes,vs.s'. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q 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.__..,f
4521 SARATOGA Village VILLAGE of CORINTH
Dist. No County or City
(If city, give street address)�
O
Name of deceased LEONARD GOULD Veteran
(If veteran, give name of War)
Single, married, widowed,
Sex..M LE Color WHITE or divorced (write the word) MARRIED Date of Death 4/4/1963 19
Age F,34 Years Months Days Birthplace RUSSIA
Cause of Death Q ON AC ARREST;MYOCARDIAL INFRACT
Certificate was signed by RICHA-RD W. PITT'IN ., M.D.
Address Q On INTH, N.Y.
Place of Burial (or Removal) SHARA TEFILA CEMETERY, GLENS FALLS,, NEW YORK
(If body is to be temporarily held,fill in space later) 1}/10/196
Cemetery Date of Burial , 19
(If body is to be temporarily held,fill In space later)
Thq 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 SULLIVAN & MINAHAN LENS FALLS NEW YORK
UNDERTAKER(Nam) INTER (Address) the body.
the to hold temporaril an
IIppsq�erJ�II�r person having charge of corpse) ( ter,rem ,o ore stab howl)
Dated.:/...(.1..1.7..� 19 (Signed)... -"err ) ... r
Local A
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part the Mate (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 S1 X'lUN OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of was ( �kn 19 c3
(Interment or Cremat )
(Name of Cemetery, Cre torium etc.)
Section Lot No. Grave No.
ad( aJ-' a
Signed)
�► -*
(Person is charge)
Address I &j4S VOL
_
Person in charge must return this Permit to
the Registrar of his Distr:.ct within SEVEN (7) DAYS
from above date. If no person is in charge, the
FUNERAL DIRECTOR or UNDERThKER MUST SIGN ABOVE STATE-
MENT, write_ aprogs the,fa'f 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 OFrENSE.
The law will be enforced. Local Registrars are re-
quired, under penalty, to report violations thereof.