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Richards, Charles NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT QgF 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. ._ 5601 Warren Town, Village Cityof Glens Falls Dist. No. County or City If city, give street address) Name of deceased Charles L. Richards Veteran Yes — WW II (If veteran, give name of War) Male Single, married,widowed, Married May2 Sex or divorced (write the word) Date of Death 3 19.79 Age 60 Years Months Days Birthplace New York S at_e Cause of Death Cardiogenic Shock Certificate was signed by William N. St.John M.D. Address 464 Glen St. , Glens Falls, N.Y. Place of Burial (or Removal) Town of Queensbury, N.Y. (If body is to be tem arily h fill in ace later) Cemetery amine iew eme ery Date of Burial May 24 19...79 (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 Regan & Denny,Inc. Quaker Rdt ,,Giene__ 'alle_,__._N4_X. (Name) (Address) the Undertaker to hold temporarily and Inter the body (Unlertaker or person awing charge of cor (Inter, remove, or otherwise dispose of (state how)) Dated ` .-& 19 _. (Signed) ___.\IN ' s.a 11 Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a bo y 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)(7A2-53) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date oil was 9 /g (Interment�r r z ©ro- 41117/6--12.4— (Name of Cemetery, Carr aloraam; €LLB.) rr / SectionL'�Z%I�h, Lot No. Grave No. /�// (Signed) (Person in Charge) 1/4- 4,7 /a 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.