Piscitelli, Elizabeth 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Vill Registered No.
Dist. No. 5601 County Warren or City &lens Falls Hospital
(If city, give street address)
Name of deceased Elizabeth Piscitelli Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the word) Widow Date of Death Dec, 2 19 .. 9
Age 56 Years 9 Months 24 Days Birthplace Glens Falls, N,Y,
Cause of Death Multiple Arterial....Thx.onbi
Certificate was signed by Richard Hogan M.D.
Address Moss Street, Hudson Falls, New York
Place of Burial (or Removal)) .......Wes.t....Glens...Fal.ls N..Y..
(If body is to be temporarily held, fill in space later)
Cemetery Wes.t...Glens....Fall.s Date of Burial Dec, 4 19 ..,6.9..
(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•
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 Carleton Funeral Home, Inc. 68 Main Street, Hudson Falls, New York
Almon C. Wilson
(Address)
lsO Inter
the to hold temporarily and the body
(Undertaker or person having charge of corpse) (Inter, re ve, or othegt i dispose of (state how))
Dated ..Dec......3 19 69 (Signed)
oca R s r
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to aanny'`part of the tate ubjg to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit PermrtY-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
•
7 Date of was 19
(Interment orematinn)
(Name of Cemetery, etc..)
Section Lot No. Grave
(Signed)
(Person in Charge)
Address X ) 6&(/'
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 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.