Thomas, Edward 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. J
Town. e
Registered No.
Dist. No. 5 ��' County oix Ct7�i Argyle
(If city, give street address)
Ldward I . Thomas no
Name of deceased Veteran
Single, married, widowed,
rc (If veteran, give name of War)
a widowed
Sex or divorced (write the word) Date of Death le 19 67
ov. 20,
Age 68 Years Months Days Birthplace Granville, 1.Y.
Cause of-Death crilshed_skull_witil_multe_tre.cture chest extremities
Certificate was signed by Li.lLaiz..cI:....GS;e taerg.. - coroner M.D.
Address Hudson Falls Ii Y.
Place of Burial (or Removal) dens :rills, Lew York
(If body is to be temporarily held, fill in space later)
Cemetery P.ineua.ew...Cemeter.y.:., Date of Burial 1vov.24., 19 67
(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 L.B.Kilmer Argyle, N.Y.
(Name) (Address)
the undertaker to hold temporarily and inter the body
Undertaker or person having charge of corpse) - (Inter, remove, or other�vAe disppese of [state how])
Dated c;;.,.,,,_Cf 1'./ .- 19.6 7. (Signed) C : n,s, X= i-C:-e--x ote��i
Local Registrar j_
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 was 19
(Interment or Cremation)
•
(Name of Cemetery,Crematorium, etc.)
Section I,ot No. r Grave No.—
(Signed) _
(Person in Charge)
Address j
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.