Grant Sr., Edward NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rgir 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.
Registered No. i
Town, Village
Dist. No. 5601 County Warren or City Glens Falls Hospital
(If city, give street address)
Name of deceased Edward B Grant Sr Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) married Date of Death Nov......2e 19 69
Age 75 Years 3 Months 12 Days Birthplace Glens Falls N.Y.
Cause of Death myocardial....Infarction
Certificate was signed by Richard Hogan M.D.
Address ..325 14ain Street Hudson Falls N.y• .
Place of Burial (or Removal) Tyan, Quee.nsbu.r..x Warren CQ N,Y
(If body is to be temporarily held, fill in space later)
Cemetery St A].phons US Date of Burial Dec. 1 19 69
(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
toCarleton Funeral Home Inc, (A.C.Wilson( Hudson Falls N.Y.
(Name) (Address)
the Funeral Directorto hold temporarily and Inter the body
(Undertaker or person having charge of corpse) (Inter, retSve, or othe rsplispose/of (si to how))
Dated } mDec......1 19 �?9 (Signed) ,i /iA`,
cal Reilistri
This This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the State(+�ubj 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 r -r.. 't l was id—or. ), 19 6)(i
(Interment or Cremation)
CYI I ( M4J ))Yd 7
(Name Cem etery, Crematorium, tc.)
Section : Lot No. a'`3 Grave No. vl
(Signed)
(Peron in barge)
Address 3,S 7 rl) A 4w ✓a C
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.