Dyson, Russell • *). 1•r Vr•An••vG•\• yr f7GMi•I fl
OFFICIAL BURIAL (OR REMOVAL) PERMIT
i, 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.
Town, Village
Dist. No. 5601 County Warren or City City of Glens Falls
If city, give str d ess)
Name of deceased Russell E. Dyson Veteran Yes —
(If veteran, give name of War)
Male Single, married,widowed, Sin le April 26 ']$
sex or divorced (write the word) Date of Death 19
Age 87 Years Months Days Birthplace New York State
Cause of Death Bronchopnuemonia
Certificate was signed by J.E. Cunningham,Jr. M.D.
Address 90 South St.,Glens Falls, N.Y.
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 29 19r?
(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 Under_ er to hold temporarily and Inter the body
(Unlertake r ers having charge of corpse) (Inter, remove, o eri is dispose f e how))
Dated )_i 19_ (Signed)
c Registr
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to y part of the Sta e (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 was /" 19
(Interment or tAeemert n)
(Name of Cemetery, ewa*o*i,n, et .)
Section ,., 'Ti Lot No. Grave No.
(Signed)
(Person in Charge)
/69<-!e;f—e___
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.