Gordon, Ella NEW TURK ,TATE DEPARTMENT OP HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
il 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. Gd)
Dist. No. 5601 County Warren o'`'o City''fie Glens Falls,
If city, give street address)
Name of deceased Ella E. Gordon Veteran NO
(If veteran, give name of War)
Female Single, married,widowed, Widowed 4_28-77
Sex or divorced (write the word) Date of Death 19
Age ars _ q__}-_-_,- Mont ,Day ' hplace F
Cause of Death , __
Certificate was signet,by Joseph Fei ,old .D. M.D.
Address Fort Edward, New York
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Cemetery Date of Burial April 30 19 77
(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
Carleton Funeral Home, Inc. Main St. , Hudson Falls, N.Y.
C. Bruce Wetmore
Inter (Address)
the to hold temporarily and the body
(Unlertaker o person having charge of corp ter, retr e •. e d' ose state how))
Dated —,)_e 19 ./- (Signed) __ ____ m � c
Local R ' trar
This Permit is sufficient for the Removal (and Interment or Cremati n) 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. 6/63) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of h�yy tom- 'Gas i� 19 'j l
(Intermentt or Grematian)_`
(Name of Cemetery,`Crematorium, etc.)
/1
Section cgZ— Lot No. Grave No. 1=
(Signed)
(Person in Charge)
Address k /
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.