Fisher, James new WVKR JIAIC YCrAKIMCNI car ricALIin
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q , 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 CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
- Registered No. _ ?C
Town, Village
4
Dist. No. -1__-- -- County6 or City
It city, street addre
tiL,
Name of deceased I _- Veteran
v
(If veteran, give name of War)
Single,married,widowed, -27
Sex ____ .._. __ or divorced (write the word • t�"v '/ Date Death //— /1 19'
Age Y Mon s a Birthplace - -. `
Cause of each �� c .��
Certificate was signed by ,/___ :-_ z_, _- M.D.
Address ' _y:,,�,-___/_ .
Place of •.1. (or Rem al) __._ _-_ „(�i l _
(If body is o be empSrarily h ld, fill ins a later
'Cemete ..cam/ Syr_�. Date of Burial /,f—1 ,.5 19__..2
(If body is to be temporarily held, fill in space later
The C' 'TIFICATE OF DEATH containing the above stated particulars having been presented to me, after careful examination,
the s. • appearing to be COMPLETE, CORRECT AND SATISFACT RY AS REQUIRED BY LAW, I have accepted the same
for rfAN'
tration, have recor e it in my L al Reco with the above st d Register umber, and on the basis thereof I HERE-
BY A PERMIT
}
)/(„__,y
t•4 - - - n_,__S. .k''.
II t
( e / (A r ss
the .._ .____ _v/LI�G(-�qr__ _ _ - . __- to hold temporarily and ___ the body
,anlertaker or pe s rf havHlg charge of corpse / (In e e othe�w,ise dispose of (state how))
Dat • /-/— / 19.._ v (Signed) ___Ll'° �'
- s�-
Local Registrar
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) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date o was )/°-7) / 19 7'‘.
(Interment or '
(Name of Cemetery, C .)..
ism.
SectiF;(4.,,h,Tivii
Lot No. /4.9`7 Grave No. 21
(Signed)
(Person In Charge)
Address
le"?)7/ /e
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
UNDERTAKER MUST SIGN ABOVE STATEMENT,
write across the face of the Permit the words "No person in
charge," and FILE PERMIT WITHIN THREE (3) PAYS
with the Registrar of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDER-
TAKERS violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOL-
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.
•
TIMER .I
•
155,156,157,
(](-1—t)
Lot`No. 16I,162,175
Address 2 Garner St., Glens Falls, N.Y. Section Nix
Owner James G. Fisher Sr.,& Peggy J. Fisher •
Oneida
Date_ 7/27/77
600 Superficial ft. @ S2.50 per sq. ft.
Location Bounded on the North by Path, East by Path, South by Savale,Bowman, Fitzgibbon, West by
Road, ,Savale & Bowman
Corner Posts
Remarks The Deed listed below replaces Deeds #1408 & 1416 which have been voided.
Deed No. (and changes) .1)11i5
Payment Record Paid in full 7/27/77
r ,
,
Form No. 01
Record of Interments
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FISHER, J'amrs G. Jr.
(j(11-1—t)
Age: 19
Cause: Shock
Lot Owner: James G. Fisher Sr.
Lot # 156 & 157, Oneida Plot
Grave #
Case: Ma Steel
Died: 11/11/76
Interred 11/15/76
Undertaker: Sullivan & Minahan