Schenk, Mary ..o.•• mvnn J1/11C vcrARImcni1 Vr ricaLiri
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Qom' 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 COMPLE E CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. � �
Registered No.
•
Town, Villa
Dist. No. 5 601 County Warren or City lens Falls
If city, give street address)
Name of deceased Mary Christine Schenk Veteran NQ
(If veteran, give name of War)
Female Single, married,widowed,
Sex or divorced (write the word) Married Date of Death March 13 19 79
Age 59 Ye rs Months„,_ 'Days Birthplac Fort Edward, N.Y.
Cause of Death - - __0 �`--c .,..- •
Certificate was signed b Si9mund Weiss M.D.
Address Elm Street dson Falls, New York
Place of Burial (or Removal) Town of Queensbury, New York
(If body is to be temporarily held, fill in space later)
'Cemetery Pineview Cemetery. Date of Burial March 16 1979
(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. 68 Main Street Hudson calls, N.Y.
(Name) (Address)
the Funeral Director to hold temporarily and Inter(-)thr
the llody
(Unlertaker or person having charge of corpse) rj, reTove, ise dispose of (state how))
Dated March 15, 1979 19 (Signed) '/.. _V\ - - --. •
-
'Joe Registra ,�
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to a y part of the State (- ubject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit ( S No.62) is required.
FORM VS. 61. (REV. 6/63) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF:REMISES ON WHICH INTERMENTS
ORCREMATIONS ARE MADE
Date of s.�a: ) % was /// L / l 19 -V e
(Interment or Cremation)
/ )
(Name of Cemetery, Ccematorlum,._etc..)____
r f
Section , t� �-� -" Lot No. �L Grave No.
Ce,
(Signed) ///
(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 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.