Underwood, Jean NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ram' 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. C�
Town, Village Glens Fall s
Dist. No. 5601 County Warren or City
If city, give street address)
Name of deceased Jean E. Underwood Veteran No
(If veteran,give name of War)
Female Single, married, widowed, Married 12/9/78
Sex or divorced (write the word) Date of Death 19
Age 48 Yptrs .. M the Days Birthplace NY
Cause of Death � r%naa �Y���A-G�.
Certificate was signed by Dr ichard Hogan M.D.
Address 325 Main St., Hudson Falls, NY 12839
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to be temporarily_held, fill ins e la r)
Cemetery West ens alls Lemetery Date of Burial 12/13/78 19
(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, NY
(Name) (Address)
the C. Bruce Wetmore to hold temporarily and Inter the body
('Unlertaker or person hav' charge of corpse) Inter rem ve or otherwise dispose of (state how))
Dated _Ti C
- \-
19 (Signed) �^ S k,
cal 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) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of t1ao4t was ��� 19
(Interment or 8renaatinni______�
(Name of Cemetery. Crem�torinm,_etc.) �_,.
Section Lot No. Grave No.
(Signed)
(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 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.