Loading...
Deyett, Lester 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. / 5657 Town, Village Dist. No. County Warren or City Wes.tmount---INf If city, give street address) Lester R. Deyette Name of deceased Veteran no (If veteran, give name of War) Male Single, married,widowed, Sex or divorced (write the word) widowed Date of Death 4-16- 19 79 Age 64 Years Months Days Birthplace N.Y. Cause of Death Re_spirator-y__F-ailure Certificate was signed by Bernardo R, Villajuan M.D. Address 90 South St. Glens Falls ,-__N .Y_. Place of Burial (or Removal) Town of Qsby.. (If body is to be temporarily held, fill in space later) Cemetery St. A ��R- nsus---Oem Date of Burial 4-19- 19-7..9_ (If body is to be temporarily a 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 James F. Singleton Inc. 314 Bay Rd. Glens Falls.,___N1_.Y, (Name) (Ad ss) the Undertaker to hold temporarily and i n-ter ___ the body (Unlertaker or person having charge of corpse) (I to rem e, or oth r ise d s ose of at to how)) Dated 4--19-79 19 (Signed) ...€'. .,- ..ate_. Local a trar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any p 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 Interment was 4-1 9- 1979 (Interment or Cremation) St. Alphonsus Cemetery (Name of Cemetery, Crematorium, etc.) Section II Lot No. P 20-SOGrave No. 2 (Signed) �/ -4/-►.-42 4- (Pe son 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.