LaPoint, Harold 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. S- 6
Town, Village Registered No.
Dist. No. 5601 County warren or City Glens Falls Hospital
(If city, give street address)
Name of deceased Harold J LAPOinI Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) married Date of Death...Qcts ber 19 19.67..
Age 67 Year 1 Monthsh..() Days Birthplace-_Sandy...Hill..N.Y..
Cause of-Death ..
Certificate was signed byRohert ones- M.D,
Address._1QO...1.ohn..Stre.et..Hu,dsan..Ealls.-N..Y..
Place of Burial (or Removal)Twn Qiegn.abury Warren .C.o....li...Y.
(If body is to be temporarily held, fill in space later)
Cemetery__.P.i.neuiew Date of Burial Qctoter 2.3 19.67
(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
tgartetAri.runeral..flome..1nc. 4A...C..W.ilson). Hidson Falls N.Y,
(Name) (Address)
thEuner31 Dxractor to hold temporarily and Inter the body
(Undertaker or person having charge of corpse) (Inner,remove, or othe`wise dispose of [state how])
Dated.Qctober 20 19..6.1. (Signed) A-...�-1. 4JLL.Z
-� L cal Re istrar
This Permit is sufficient for the Removal (and Interment or Crematior2'} ofdy 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 --- - 1_ was ! 19_
(Interment oratiglp)
•
l / ,
(Name of Cemetery,
/Crematorium, etc.)
1
Section_—.__ Lot No.,: = Grave No ___
(Signed) G_k _- Cs_t1 ( �{
(Person'in C arge)
Address t_ . ' _ t_/2/--- - ...5.(�... --' '/ ---
/ J ,J ,
Person in charge must return`t< � ,his Permit to the Regis
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.