Fish, Milla Form VS.a. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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._..62
5726 Wash. Village Hudson Falls,
Dist. No County or City
(If city, give street address)
Name of deceased Mi l la Fish Veteran — — —
_ Single, married, widowed, Nov
(If veteran, give name of Wax)
Sex Fe— Color or divorced (wnte the word) Single Date of Death . 21, 19 63
Age .6.2 Years Months Days Birthplace Glens Falls, NY
Cause of Death Axt, ,o—sclerosis, generalized -
Certificate was signed by Cr.,,y., Lati,mer M.D.
Address Hudson Falls, N. Y.
Place of Burial (or Removal) Tom. of Queensbury, N. Y.
(If body is to be temporarily held,fill in space later)
Cemetery St. Alphiop bus Date of Burial Nov. 23, 1.963 19
(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 ,Tohn Sullivan Glens Falls, N. Y.
(Nana) (A as)
the Ikudertakez to hold tern °ran an ,. x.31, 0.r .the body.
(Undertaker or person having charge of corpse) mov ,or othe nose [state h
Dated am, 21, 19 63 (Signed)
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 CREMATIONS
ARE MADE
Date of GLJ?..t,� was ?' ;3"`z1- .319
(Interment or £Ro.. MT)
{'' .'1 ��
( me hf time tery, remetorfum, etc.)
„,
, r Waif i
Section ri.,..,--,00,..k ; Lot No. i Grave No.
t
(Signed)/e „
w O (Hreon char ) �C n r, G�
r C/J QA. Y (�(r
Address 6. a O
i •
Person in charge mast return this Pe it 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.