King, John NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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. 3,8-
Registered No.
Town, Village
Dist. No. 5601 County Warren or City City of Glens...Falls
(If city, give street address)
Name of deceased John R, King Veteran Yes - WW....I.I
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) ...Married Date of Death July....2.1 19 .7.7
Age 55 Years Months Days Birthplace....N.e.w....York...S.tate
Cause of Death Carc .no.na...o.f....lung.
Certificate was signed by Harry...M.......D.ePax1 M.D.
Address Glen St, ,.Glena....Falls, N.Y..
Place of Burial (or Removal) Town Qf Queensbury
(If body is to he temporarily held, fill in space later)
Cemetery Pine View cemetery Date of Burial July 25 19 ..,,7.7.
(If body is to be temporarily held, fill in spacerater)
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
(Under er or person hav charge of c r/e) (Inter, re , or o wisZ�sp�e�f (state how))
Dated .... J 19 (Signed)(Signed) An
�I�j►���+
ocal Registrar
This Permit is s.fficient 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. 6/83) (9A2-205) •^ '-•CD
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 1L r I"1 was t519_Z..
(Interment or Cremation
E �cZt
(Name of Cemetery, Cfematefiium-,--ere.)
r
(L- �c L A4 ` i ,,.._ / l S —_.
Section Lot No. l Grave No.
(.�� .
(Signed) ��c rc s
(Person in Charge)
/
Address
�i/t-i�J LG /e49,
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.