Martindale, James NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Zgr 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 WRIT'i`EN IN DURABLE BLACK INK.
Registered No. 1 d
XQi, Village Greenwich
Dist. No.5722 County " 1-1.1,D.i;t.QR Ity
(If city, give street address)
Name of deceased Jame H. jdartindale Veteran No
(If veteran, give name of War)
;'fiale Single, married, widowed, "idowed Oct 2 60
Sex
Ae... or divorced (write the word) Date of Death 1
Years ....Months Days. firth lace.. Smiths Basing N..
Caiseof'Death Cerebral vascular Accident - Arteriosclerosis
Certificate was signed by H• Leith Skinner M.D.
Address Gre�>nwrdh
Place of Burial (or Removal) Town of Queensbury
(If body is to be tLnr orarily qeld, II in space later) - t"� Que nSbury
Cemetery N�Ote11 Le►metery, Bay' , oad4 1 own cI' Date of Burial Oo.t.Q.b.e.r...5 146..._
(If body is to he 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 nar:ol:gt Ile R F1y . Gar. enwiQh, N, i a
Unde rt akekName) int eiViddress)
the to hold temporarily and the body
(Undertaker or person having charge of corpse) (Inter,remove, or otherwise dispose of [state how])
Dated O.ct...t. 19.b.b. (Signed) / i..,...._. :t., .,...1.... �`- c_
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, 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 of f" was_ ." f�( -i ' 19
(Interment or Cremation.)—
.1 (, G�
(Name of Cemetery, Crematorium, etc.)
Section_ Lot No. Grave No.__
(Signed)
(Person in,Charge)
Address y I C �_--f / t,
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.