Weintraub, Anna NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
nr 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. 19
Town, irelage<
Dist. No. 5756 County Washington =gitp( Granv 1 I le
If city, give street address)
Name of deceased Anna Berkowitz Weintraub Veteran No
(If veteran,give name of War)
Single, married,widowed,
Sex Fema I e or divorced (write the word) Widowed Date of Death Apri I 22 1978
Age 94 Years Months Days Birthplace Cz.ec.hil w kfx
Cause of Death Myocardial ._Infarction
Certificate was signed by M. J. Lynch M.D.
Address Granville, New York
Place of Burial (or Removal) Queensbury, New York
(If body is to be temporarily he f'l,i sp a later)
Cemetery bhagra 'et t is Cemetery Date of Burial Apr I 24 i978
(If body is to be temporarily field, 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 Potter Funeral Service Glens Fells, New York
(Name) (Address)
Undertaker Inter
the to hold temporarily _.�.___ the body
(Unlertaker or person having charge of corpse) r, remo or th 's ispose of (slat how))
i
Dated Apr I 22, 1978 19 (Signe e
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)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of / h "���'"�1 was 7r��/ Af 19
(Interment or Cremation)
r- 7
(Name/of Cemetery, Crematorium, etc.)
Section Lot No. Grave No.
Si ned) , YS 1 � 1
( g v.) , ,
( erSon in Char e)
U
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 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.