Truesdale Sr., Erskine ..cvv IVRn JIMIC socrmn 1 mcm I yr nCALIn
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.
5601 Warren Z- 7
Town, Village Glens Falls
Dist. No. County or City
If city, give street address)
Name of deceased Frskine J. Truesdale Sr. Veteran WW 1
(If veteran, give name of War)
Male Single, married,widowed, Married 3/5/77
Sex or divorced (write the word) Date of Death 19
Age 79 Years Months Days Birthplace NY
Cause of Death Congestive Heart Failure
Certificate was signed by Richard Hogan M.D.
Address 325 Main St., Hudson Falls, NY
Place of Burial (or Removal) Town of Queensbury
(If body is to be temporarily held, fill in space later)
Cemetery Pineview Cem, Date of Burial 3/8/77 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 ____C_a_r_l_et_on__.Funeral__Ho_me_,_._I_nc..,._Plain__St. , Hlids_on__Falls,__NY
(Name) (Address)
the C. Bruce Wetmore to hold temporarily and Inter the body
(UnleFta er or perspt having charge of corpse (Inter, remove, or otherwise dispose of (state how))
Dated 1 L L't--C .. "7 19../7 (Signed)
eg
This Permit is sufficient for the Removal (and Interment or Cremation) of a body any part of the a (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 of was 19 f 7
(Interment or 2rema4tie41-) _:;
(Name of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
(Signed)
(Person in Charge)
Address ' )D
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 UNDF
TAKERS violating the law relative to the return of permits!
are liable to a penalty of NOT LESS THAN FIVE D
LARS NOR MORE THAN FIFTY DOLLARS FOR TH
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.