Binn, Jennie I1G111 TVKK 3IAIC YCrAKI MCP'1 Vr r1CALlr1
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.
Registered No. ...o.7l /
5755 Washington Town, ale
Dist. No. County 9 or?C`ity Ft. Edward
If city, give street address)
Name of deceased Jennie D. Blinn Veteran no
(If veteran, give name of War)
Single, married,widowed,
Sex Female or divorced (write the word) widowed Date of Death Sept, 1 19 78
Age 88 Years Months Days Birthplace Caldwell, N.Y.
Cause of Death C V A; Gen. Arteriosclerosis
Certificate was signed by Allen L. Kauffman M.D.
Address 1 Pleasantview Drive, Hudson Falls, N.Y. 12839
Place of Burial (or Removal) Pineview Cemetery, Town of Queensbury, New York
(If body is to be temporarily held, fill in space later)
Cemetery Pineview Date of Burial Sept_„ 5a 1978
(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. 68 Main St. , Hudson Falls, N.Y. 12839
(Name) (Address)
the C. Bruce Wetmore to hold temporarily and inter the body
(Unlertaker or cp�er n having charge of corpse) (In remove, or therw. dispose of (state how))
Dated //� 19.7g (Signed)
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) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of a64;—lr-1-1J--was . r9 74.7
(Interment or ation) ,
CIttaaat
kl -_''t � me o terY, ium etc.)
Section Lot No. 7Grave No. Cv
(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.