Flanagen, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
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 COMPL �
TE CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Q
Registered.No. Q
5Z fit/// J� Town, Village /G�
Dist. No. County or City .7:„
If city, give street address)
Name of deceased G -%,-. J Veteran
(If veteran, ' e name of War)
Single, married,wid ed,
Sex
or divorced (write the word) /t--462C'eJ Date of Death ;I 19.... 7
Age ....76 Years _ .- _ Mo the ays . Birthplace n d-,Cause of Death
Certificate was signed by M.D.
Address ��
-
Place of Burial (or Removal) _...4.2r=ip
~(If body is to b .poraril el , f' i IV:
r�Cemetery _ Date of Burial _.1,. Z,? 19-__1•,"
(If body is to b'e temporarily he , fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,
the same gearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for registra 'on, have recorded it in my Local Record with the above stated Registered Number, and on t basis thereof I HERE-
BY G - ERMIT
to _ - .(1 - --1,..
(Na e) (Address)
the to hold temporarily and the body
(Unlertaker rson�javing charge of corpse) (Idt em , or erwis dispose of (state how))
Dated / 19." 2 (Signed) ��/
/ Local gistrar
This Permit s sufficient for the Removal (and Interment or Cremation) of a body to any-[fart of t e State1 subject to local
cemetery or othe regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM VS. 61. (REV. 6/63) 18A2-78)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of Tnt;er-nent was :.' — 19
19
(Interment or Cremation)
St. Alphonsus
(Name of Cemetery, Crematorium, etc.)
Section , S r, r,. ,T)v bt No. ) . _ i H.Grave No.
(Signed) (.
(Person in Charge)
Address 35 Broad. St. , Glens Falls, NY
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.