Bushey, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
aSr 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 CER-
TIFICATE OF DEATH, LEGIBLY WRIT3`EN IN DURABLE BLACK INK.
Town, Registered No aDist. No. 5657 County Warren Cleverdale
(If city, give street address)
Name of deceased JOSEPH N BUSHEY Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Malo or divorced (write the word) !idclwe_d Date of Death Se.pt.17 19...64
Age 68 Years. 0 Months 8 Days Birthplace St albus O3 RBIs.'.
Cause of-Death Coronary Artery Disease.
Certificate was signed by Wi,11i-sea..S.t-.John M.D.
Address...1.53..aa50.4 t ,91,QJ48- 1411$ -0:1.
Place of Burial (or Removal) Tom u_4ens.bt 'y 'Farren Co. .r., •
(If body is to be tsmporarily held, fill in space later)
Cemetery ,.eQ3..ye Date of Burial Sept. 21 19.61.
(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 Carleton FuneralHoneInc.HudsonFalls 11.Y. (A.C.Wilson). Hudson Falls N.Y.
Funeral Lirector(Name) (Address)
the to hold temporari and Inter the body
(Undertaker or per having charge of co se) (Inter,-removei o e dispose of [stater I)
Dated — i iY 19 .! (Signed) .l.4,4. a fc Ce-hz 4l {'-{
),, / Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of, bod tb any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in whic case a Transit Permit (VS No, 82) is required.
Form VS. 61. (Rev. 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date <> _w 19 I,/
• (Interment'or Cre n
(Name f Cemetery, Crematorium, etc.)
Section_ T•ot No. Grave No.
(Signed)
(Perso in ge)
( 1.--
Address
�
{ /
Person in charge must eturn this Permit to the strar
of his1 District within SEVEN (7)'DAYS from above date! If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and FILE
PERMIT WITHIN THREE (3) DAYS with the Registrar of Dis-
trict 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 required, under penalty,
to report violations thereof.