Waite, Rose NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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 WRITTEN IN DURABLE BLACK INK.
..4c-- Registered No.
Dist. No. __.3601.. County Warren or City Glens Falls Hospital
(If city, give street address)
Name of deceased Rose Waite Veteran. No
(If veteran, give name of War)
FemAle Single, married, widowed, aried Date of DeatlPctober 3 19 65
Sex or divorced (write the word
Age 67 Years 2 Months 2.7 Days Birthplace Moriah N. Y.
Cause of-Death Myocardial...Infraction
Certificate was signed by.Williattm St John. M.D,
Addres464...Cr.1�tl�..Saxeet..Glens:..F..alls„N..Y...
Place of Burial (or Removal) Town Queensbury Warreb Co, N,Y.
(If body is to be temporarily held, fill in space later)
Cemetery Pine._View , Date of BurialOctober 26 19 65
(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 Funeral Home Inc,kA,C,Wilson) . Hudson Falls N,Y.
Funeral Directorme) Inter (Address)
theto hold tempera ' and the body
(Undertaker or person having charge of corpse) ( remove, or therwise dispose of [state how])
Dated October 25 19 65 (Signed)
Loca Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to a 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) (3A2.323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date ` writ�" C'- -'t ' 19 c`,, .r� _.
(Interment or Cremation)
Lzp c_ ,,,-- 1
(Name of Cemetery„Crematorium, etc.)
Sectiozi 'y Lot Noj _..7
' Grave No. -2--_
_L-.-- ill ^ /
(Signed) - '�L t�(
(Person in Charge)
Address /� L-7:3
x'- -, c' �-- -__,,C
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 or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face 04 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.