Berryman, Lyel NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
far 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. 4601 County Schenectady or City Schenectady
(If city, give street address)
Name of deceased Lyel Berryman Veteran
(If veteran, give name of War)
Male Single, married, widowed, ..ESept.Sp
g
Sex or divorced (write the word) Married Date of Death P 10, �Y
Age 61 Years .Months Days Birthplace Michigan
Cause of Death Diabetes Melletius
Certificate was signed by Dr. Boonyindee M.D.
Address St. Clare's Hospital.
Place of Burial (or Removal) Queensbury, N.Y.
(If body is to bet porarii* a d, fillin space later)
Cemetery Fine View em. Date of Burial Sept. 13, 1969
(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 examination, the
same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra•
Lion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PoERMIT Griswold Funeral Home 1867 State St., Schenectady, N.Y.
Name) (Address)
Undertaker Inter
the to hold temporarily d the body
Dated nderta• r o pets havi g,clirge of corpse) (Inter, remove, or therw e dispos of (state how))
ept, 1.L, i 19 (Signed) -...v
Loca 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 OR
CREMATIONS ARE MADE
Date of "C}`-Z'L�f// l/(6s '�%�''" /819
(Interment oEreaaatiou).._ �C
t T
6-1‹.-L-_ Kr4-C-&A—
(Name of Cemetery, C--kil,e+f)-0-6-1
tc.
Section dC , j Lot No.._2/1 Grave No.
(Signed) Yj ( ':A-tn",.i-.__,
(Person in Charge)
.....,
Address /17
��/ 5
Person 4 n charge must return this Permit to the RegistAr
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.