Foley, Ambrose 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. rp
Town, Village Registered No.
Dist. Na. 5601 County Warren or City Glens Falls Hospital
(If city, give street address)
Name of deceased Ambrose M Foley Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death August 17 19 65
Age 62 Years 7 Months Days Birthplac4utland Vermont
Cause of-Death._
Certificate was signed by Macdgn ,
ld Mclkee M.D.
Address South Glens Falls...NAY.
Place of Burial (or Removal)..., TwI7l..QLl Q.ilakt,1 '-y Warren Co, N,Y.
(If body is to be temporaril held, fill in space later)
Cemetery Pine View Date of Burial August 18 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.Carleto.nEune.ralkisameI.n.clIudsranFaus....(.A..C.Wilsonj. Hudsam..l~a1ls_..N„Y•
Funeral Directoz<N8111C) (Address)
Inter
the to hold tempo rily and_ the body
(Undertaker or person having charge of corpse) ter,remove otherwise dispose of [state how])
Dated.Augu.s t /7 19 65 (Signed)
(calRegistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body topart 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. 6I. (Rev, 6/63) (3A2.323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS (IR
CREMATIONS ARE MADE
Date o wad ' 19 T `
.t,rmpmror Cremation),,
(Na a of ometery,.Crematorium, etc,)
Section / 2--" Lot No. Grave No. _
(Signed) _
(Person in Charge)
Address' k
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 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.