Hichman, Evelyn 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.
Registered No. !
7601 Warren Town, Village City of Glens .Falls
Dist. No. County or City
If city, give street address)
Name of deceased Evelyn R. Hichman Veteran No
(If veteran, give name of War)
Single, married,widowed,
Sex Female or divorced (write the word) Married Date of Death Feb. >?0 19.s'I.
Age 42 Years Months Days Birthplace New York State
Cause of Death Generalized Metastasis of Carcinoma of Breast
Certificate was signed by Joseph Feingold M.D.
Address Fort Edward, N.Y.
Place of Burial (or Removal) Town of Queensbury
(If body is to be temporarily held, f'1a1 in space later)
Cemetery dine view Cemetery Date of Burial Feb. 22 19 r78
(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 Undertaker to hold temporarily and Inter the body
(Unlertaker or„per n having charge of corpse) (Inter, remove, or otherwise pose f (state how))
Dated j- 7' 19---7-6 (Signed)
r
This Permit is sufficient for the Removal (and Interment or Cremation) of a b d o any part of t State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a ansit Permit (VS No. 62) is required.
FORM VS. 6t. (REV. 6/63) (6A2-130)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of'`:C9:2 �'y'1 was .2219
(Interment or
(Name of Cemetery, Creaaatpyum,
Sectionot No. l ` Gr o.
C_-)re &ck So CjrQue G•
(Signed) C '/"/9-7e)
(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 e`ta ,�.
charge," and FILE PERMIT WITHIN THREE (3) DA
with the Registrar of District in which cemetery is located
SEXTONS, FUNERAL DIRECTORS and UND
TAKERS violating the law relative to the return of perms'
are liable to a penalty of NOT LESS THAN FIVE DO '` ,
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.