Dupont, Jeannette NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. � a r/
Registered No. d
�1 Warren Town, Village Cityof Glens Falls
Dist. No. -"'-" County or City
If city, give street address)
Name of deceased Jeannette V. Dupont Veteran No
(If veteran, give name of War)
Single, married,widowed,
Sex Female or divorced (write the word) Widowed Date of Death ._Sept2__.29 19..?7
Age 23 Years Months Days Birthplace Canada
Cause of Death Cardio-respiratory Failure
Certificate was signed by Harold J. Luria M.D.
Address 25 May St. ,Glens Falls, N.Y.
Place of Burial (or Removal) Town..of_._Cueenabury,N_,Y_e
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Cemetery Date of Burial Oct. 3 19_2_7
(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 Regan & Denny, Inc. Quaker Rd. ,Glens Falls, N.Y.
(Name) (Address)
the Und taker to hold temporarily and ____ Inter the body
(Unlertak perypn�ving charge of corpse) (Inter, ove, °ithe e d ose of (state how))
Dated L 197_. (Signed) ���J•
Local Registrar
This Permit is sufficient 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. 6/63) (6A2-130)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
2 Date of was Ly � 19 7,7
(Interment or erernat on
(Name of Cemetery, ium, etc.)
/, '
Section Lot No. /S Grave No. /
A-.,,,„„/
(Signed)
(Person in Charge)
Address /e '
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 STATEMOT
write across the face of the Permit the words "No person
charge," and FILE PERMIT WITHIN THREE (3) DAV
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.