Hall, Estus porm v&iL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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 CERTIF SIE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.__...•-.-.•-•--•••-•—
Dist. No Se?91 county o VillageC City of Glens Falls
;If city, give street address)
Name of deceased Estus S. Hall Veteran Yes ® WW II
Single, married, widowed, ([f ♦seven, give name of War)
Sex.N& . Color..nite or divorced (wnte the word). 4.aX:X:ied Datit of Death...April...14 19.7.7.
Age 67 Years Months Days Birthplac NTev••Ya k..,State
Cause of Death S1rXQX:e...$i7,RGka....Q.QX1.g Ati.Y.0...11,l X.'t... s,1.1.U-X'.e.
Certificate was signed by Ja41e, .F.A...1'1QC:x: ,,.a.say M.D.
Address $9.14: ti. .5.t r..s.G ,.4'.111? F a1.1.4.1. N,e.Y.s
Place of Burial (or Removal) ;,'.Q3K11. .0. Q.11Ge.n.o.bt `,ys T,yi
(If body Is to be temporarily held,fill In space later)
Cemetery P.x1v Vi.OW...CQIt?.e.ter.Y Date of Bunal. April • . 7 19
(If body is to be temporarily held,e11 In space later)
The Certificate of Death containing the above stated particulars, having been resented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFA( 'TORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Reco rd with the above stated Registered
Number and on the basis thereof I HEREBY GRANT A PERMIT
to 1egan & DennylInc, quaker R A.AGl pn'1s F.411A,-._NAY.,
(Name) (Address)
the tbad.r.tc'1k.er to hold temporarily and ...I ter the body.
(Undertticer or n haying charge rpse) (Inter, ov e,or otherwise dlsnose of[state how])
Dated /s3 19..i....J (Signed) Loc"aNlteg••
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of th� (subject to local
cemetery or other regulations), unless removal is by common carrier,in which case a Tra nait Permit (VS No. 62) is required.
ENDORSTMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date of _ Le.� ' Z) /119 /1,
(Interment or gnome t+^^).
(.7".'f.,4,-.1.; / ''' ''---<'14','4: (—
(Name of Cemetery, Ore—MingrItmr,--e-to...),„-
iti 4 6, c e� /
Section of No. y/"9 Grave No.
IN
(sign --4 e L__4, _ ____
r:-)
`-- (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 DIREr ut o.jUNERTAK � .em r ewvF rgE nw
MENT,
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 re—
quired, under penalty, to report violations thereof.