Stewart, Kenneth ricvr 1VKK 31AIC YCrAKIMCNI Vr IlCALIM
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ll* 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 COZY LETE CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. `t
Registered No. ,2
TOGNi
Dist. No. 5601 County Warren oMitralgISr City Glens Val ls
If city, give street address)
Name of deceased Kenneth William Stewart Veteran no
(If veteran, give name of War)
Single, married,widowed,
Sex male or divorced (write the word) single Date of Death 6/27 19 76
Age 69 Years Months Days Birthplace Hudson Falls, NY
Cause of Death severe pulmonary emphysema
Certificate was signed by M.D.
Address 325 Main St. , Hudson Falls, NY 12839
Place of Burial (or Removal) Tn of Queensbury, NY
(If body is to be temporarily held, fill in space later)
Cemetery Pi neview Date of Burial 6/28 1976
(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 examination,
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 HERE-
BY GRANT A PERMIT
to Carleton Funeral Home, Inc. Hudson Falls, NY
(Name) (Address)
the Funeral Director to hold temporarily and inter the body
(Unlertar or�e t'pn having charge of corps?) (Int emove, or otherwise dispose of (state how))
Dated — 192 _ (Signed)
1���,,��..
`ti •
This Permit is sufficient for the Removal (and Interment or Cremation) of a dy 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.
FORM VS. 61. (REV. 6/63) (4A2-179)
ENDORSEMENT OF SEXTON O VERSON IN
CHARGE OF PREMISES ON WHIG INTERMENTS
OR CREMATIONS ARE MADE
Date of;;(-Z:kkliev".
was .119_/
(Interment or Crem on)
-461/.-e A---4.- . -/N. '-6' 4
(Name of Cemptery, aa,.
Section /9 Lot No. C,-11L7Grave No.
(Signed) 411 (.;:At-1-c...-2.---p-
(Person in Charge)
Address j " `; V-
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 DIRECTOR r
UNDERTAKER MUST SIGN ABOVE STATEMEN
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 locate
t 1'
SEXTONS, FUNERAL DIRECTORS and UNDEI!.:,
TAKERS violating the law relative to the return of permits,
are liable to a penalty of NOT LESS THAN FIVE DOL-'
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report,violations thereof.