Gould, Bessie 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. 7
Town, Village Registered No.
Dist. No.. '52iJ County Saratoga or City COr int k'
(If city, give street address)
Name of deceased ffe s s ie Gould Veteran no
(If veerac came of War)
Single, married, widowed, ,
Female i Widowed March 6'
Sex or divorced (write the word) Date of Death .._. 1
Age 73 Years Months Days Birthplace......_Russia
Cause of-Death Myocardial...in arct
Certificate was signed by Richard Pitkin M.D.
Address Gorinth,l N.Y. __
Place of Burial (or Removal, Sha ey Pet lift. Cemetery,_ Town...of...Qieensbury'
(If body is to be—temporarily
jY, e ff
mppo rily het S. later)
Cemetery �� y eigy Cemetery. ... ._. ...�_"�t, or ,_,_._, Parch .10. .................. 19 6
(if body is to be temporarily held, fll
The Certificate of Death coi:..:r:i:l ;he 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 Thomas-, G. Monahan Glens Fells, New York
(Address)
Name) inter
the Undertaker to hold temporari and the body
Undertaker r person having charge of cgs e) Int r,remove, otherw pos of [state howl)
Dated M1arch 1D 19a0 (Signed) :0./111—/
Local egistrar
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, 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 of __ was __19______,
(Interment or Cremation) •
(Name of Cemetery, Crematorium, etc.)
Section_—__ Lot No. Grave No.___
(Signed) — — —(Person in Charge)
Address
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.