Loading...
Ferguson, Milton 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. CC�� Town, Village Registered No. ...1...7 Dist. No. 5601 County Warren or City City of Glens Falls (If city, give street address) Name of deceased Milton M. Ferguson Veteran No (If veteran, give name of War) Single, married, widowed, Sex male or divorced (write the word) .....Marr.i.ed Date of Death ....June 11 19 ..7.7.... Age 74 Years .Months Days Birthplace N.Y.S. Cause of Death Congestive Heart Failure Certificate was signed by James F. Hindson M.D. Address 90 South St. ,Glens Falls, N.Y. Place of Burial (or Removal) TOWn of Queensbury, N.Y. (If body is to be temporarily he d, fill in space later) Cemetery li.ends....C.em.e:G.ery Date of Burial June 14 19.,77 (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 Regan & Denny,Inc, Quaker Rd. ,Glens Falls, N.Y. (Name) (Address) the Undertaker to hold temporarily and Inter the body (Undertaker r pe)Ion having charge qi rgrpse) (Inter, rentE)e�, or wise di os o/0 Y 1 .. /j ( tote how)) Dated ll�> (Signed) - s.- Loco gistrar This Permit is sufficient for the Removal (and Interment or Cremation)of a ody 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. 6/66) (9A2-206) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of Sirt was � 19 ! 7 (Interment or Cr ation) /�► Ai:et.44/4; \./{' (Name of Cemetery, Cremat um, etc.) Section Lot No. Grave No. (Signed) erson in age) Address /-tFo/ Person in charge must return this Permit to the Registrar of his District within SEVEN (1) 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.