Parkhill, Ruth NEW 'PORK 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. - 'j
Town, Village
Dist. No. 56n1 County Warren or City Glens Fa" s
Ruth T. Parkhill. If city, vOe street address)
Name of deceased Veteran
(If veteran, give name of War)
Female Single, married,widowed, Widow 10/1.3/79
Sex or divorced (write the word) Date Qeath 19
Age 87 Years Months Days Birthplace
Cause of Death Congestive Heart Failure
Certificate was signed by William St. John M.D.
Address 464 Glen St. , Glens Fails, NY
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to be tern orarily_held,fill in space later)
scotch Cemetery 10/15/79
Cemetery Date of Burial 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 Inter
to hold temporarily and the body
(Unlertaker o p rson hang charge of corpse) If r ve, o -littler ise dispose of (state how))
Dated l Li /0 19-... / (Signed) ' i � f
Lo Registrar\ v)^'Y
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) (6A2-130)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of S2/<f— 1‘/ was ` v19 /
(Interment or Cfrex ►iios4-
(Name of Cemetery, C.rpmatnriurni--ete:}--•--.- ®^
Section Lot No. — Grave No.
(Sign
(Person in Charge)
Address 44ff" �� / ����•
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.