Gilbert, William NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
I« 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.
Town, Village
Dist. No. 198 County Albany or City Albany
If city, give street address)
Name of deceased William Veteran WW...II
(If veteran,give name of War)
Single, married,widowed,
Sex Male or divorced (write the word) Single Date of Death 10/__2/ 19-.7.7..
Age 74 Years Months Days Birthplace New .York
Cause of Death Cards.U-pnlmgxlary_...arrest
Certificate was signed by Rodney...J_.__._Taylor M.D.
Address VA___Hosp.ital.,.. .113 Holland Avenue ,.._Albany_,_.__Hew..Yark
Place of Burial (or Removal) Glens Falls New York
(If body is to be temp§ririly held space later) ]Q�rJ 77
Cemetery Alphonse Date of Burial 19
(If body is to be 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 registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE-
BY GRANT A PERMIT
to James F. Singleton, Inc. 314 Bay Road, Glens Falls, New York
(Name) (Address)
the undertaker to hold temporarily a, , In r the llody
(Unlertaker or person havin ch a of corpse) Inter, remove, r of ise dis se of to e<how))
Dated 10/ 19 ? ' p(Signed) . !�'-�- -4�,p t ,.14.7Z ..
Local Registra /
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of a State (subje 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) (6A2-130)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of , ="`i'" was /d `i 19 7 7
(Interment or Cremation)
(Narne of Cemetery, Crematorium, etc.)
Section / Lot No./ Grave No.
(Signed)
(Person n Charge)
/ 4'
Address 1 �G _ .cCfa,<-r�,�i� �:�, �-� i �• � ,
/ L
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) DAYS
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.