Lawton, Elliott 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. ..5601 County Warren or City City of Glens Falls
(If city, give street address)
Name of deceased Elliott John Lawton Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death August 27 19 77
Age 72 Years Months Days Birthplace Missouri
Cause of Death Acute myocardial infarct
Certificate was signed by Harry M.DePan M.D.
Address 407 Glen St. ,Glens Falls, N.Y.
Place of Burial (or Removal) Tn of Queensbury, N.Y.
(If body is to he temporarily held, fill in space later)
Cemetery S.eelye....Cemetery Date of Burial August 31 19 77
(If body is to he temporarily held, fill in space rater)
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 Ragan...&...Dez ray_,Inc, quaker Rd.,Glens Falls, N.Y.
(Name) (Address)
the UD,G3,e `t4k,Q.,X' to hold temporarily and Inter �� the body
(Undertaker or person having charge of pse) (Inter, re ve, or erwise is o of state how))
Dated '' 1 d 19'j (Signed)
,
Local R is[tar
This Permit is sufficient for the Removal (and Interment or Cremation)o f a`bod t an art of the State subject to local cemeteryor
�,any (subject
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) (9A2.205)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of
C! �Y�E+c was a 3/ 19 /7
(Interment or Cre�+ntion)
f
C -i- t t^-
(Name of Ci tery, Crematorium, etc.)
Section Lot No. Grave No.
(Sign
(Person in Charge)
Address
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.