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Hager, James 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. /1)/ Town, Village /�� Dist. No. 5-‘0/_ County or City "a-1.'�c-�, If city, give street address) Name of deceased . • iii Veterans ( �‘C) (If veteran,give name of War) Single, married, Idowed, Sex l'17'-- ' or divorced (write the word) 7 iNAA,ce.„( Date of P, ath ...Y 19. Age b.D_..,._._._ Yearsc o23 s D Birth lace '. , - L Cause of Death J /� F - �a� .7...�. Certificate was signed .... . . J M.D. Address �- , Place of Buria or Removal) ---- --. , 7 (If body is to bet orarily hel dill s ce later) / .� 'Cemetery !� v Date of Burial (� f �- 19.... LL• (If body is to bet porarily 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, have accepted the same for registr on, have recorded it in my Local Record with th above stated Regist Num: anda5is thereof I HERE- BY GRA PE T y,� to • -:.c, tt, V ©/1 - - ( cc.2.�ii1/4..... -- , 7 ( am (Address) the ((yr,. to hold temporarily and ..: the body (Unlertaker or pers h ving charge of corps (Inter, remove, or otherwise dispose of (state how)) Dated l 19.. cir (Signed) This Permit is sufficient for the Removal (and Interment or Cremation) of y to a e (subject to local cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit S o. 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 ��' -�- was C2-x li 4�19 7� (Interment or n ----ee____.; .)7.:C-Ze.e.)---- (Name of Cemetery, a orum, a c. -----__ Section Lot No. J Grave No. (Signed) (›- Q•471"4",---1 tz:441 (Person in Charge) Address *(--771? " _` ' J��$�. 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 permitte 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. HAdER Address West Mountain RD. RD#2, Glens Falls, N.Y. Sto 1 i Owner June E. Hager Plot anpida Date 6/9/78 200 Superficial ft. oTi $2.50 per sq. ft. Location Bounded on the. N^rtb-bar Roadr F.aat ley Vacant, South by Vacant, West by Path Corner Posts Remarks Deed No. (and changes) 1b87 Payment Record 9 Paid in full 6/31/78 5 le) -013D -C1\, 5 (So 41b Form No. 01 Record of Interments 1 5 2 James V_ Hager (Ei/l 9/7R) 6 S June E. Hager 2/2/96 7 4 8I A 1 x NAME Hager , James V. Age: 60 (III Cause: Cancer Lot Owner: June E. Hager Lot # 5&14 Oneida Grave # 2 Case # Concrete Died: 6/9/78 Interred: 6/12/7 8 Undertaker: Sullivan & Minahan