Thorpe, Elijah NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
s ' 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village Registered No.
Dist. No. -3a 974/ County Oneida or City Marcy
(If city, give street address)
Name of deceased Elijah J. Thorpe Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death January 28, 19 69
86 3 4 .. a Birth/��Raleigh, North Carolina
Age ea s Months y Birthpl
of Death '‘L. } 4C"'4'�C AAi L. ......... .. .7+
Certificate was signed by Dr. Paul Dissen M.D.
Address Marcy State Hospital, Marcy, New York 13403
Place of Burial (or Removal) Town of Queensburg, New York
(If body is to he temporarily had, fill in s ace later)
Cemetery .ineview Cemetery Date of Burial February 1, 19 69
(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 examination, the
same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to Regan S Denny...Fune-xa.1..kle.ryjce Glens...Falls.,...Ne .. .ork
Charles A. Gallagher
the body
to hold temporari y d Inte.
(Undertaker or person having charge of corpse) (Inter, remov or of ,wise i ose of (state how))
Dated uanuai'Y , 19 6 Si ned ..
(Signed)
g ) Local Re is rar
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 OR
CREMATIONS ARE MADE
Date of "''•�'"'1244' was t'r 19 �'`
(Interment or' on)
(Name of Cemetery, c.)
Section . Lot No. /C.” Grave No. I
\ 1 CZ Axi
(Signed) di
(Person in Charge)
Address 4// - &-l'f-7;f4-----C/1\* ' .
Person in charge must return this Permit o 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 District 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.