Meyer, Fred Ir Cv1I IVRR JIA1C YCrRR I mu CIa 1 !or rICAL In
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
��, Village
Dist. No. " �7 ‘ County 'ashy npt_on. otc4,1c Hudson falls
If city, give street address)
Name of deceased Fred C Meyer Veteran no
(If veteran, give name of War)
Single, married,widowed,
Sex male or divorced (write the word) .__married_ Date of Death 4,L24 19_' j__
Age ov Years Months Days Birthplace Bremerhaven, Germany
Cause of Death metastatic rectal CA
Certificate was signed by Dr JcIbn Bu1ova M.D.
Address 407 Glen St, Glens Falls , I'y
Place of Burial (or Removal) Tn of Queensbury
(If body is to be temporarily held, fill in space later)
'Cemetery Pineview Date of Burial 4/27 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 Iuneral Homes Ixl.e.__. Hul.aon -"E11s-,__a'1%Y
(Name) (Address)
the f'Ilner_al___dir_BGtor to hold temporarily d •
e the body
(Unlertaker or person having charge of corps Inter, remove, or wi d' pos state hew))
Dated----C =1 'L `�,, 19_ (Signed) .(�'_ �=1' )` L�i_ ,_:k<E.
Local Registrar
This P mit 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) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of C;46Arii-e'44was / 19 71'
(Interment or lma_i4'14/j"
e-771--1:L-1? V °4d
(Name of Cemetery,cemeforrn!n etc.)
Section 6' " "Lot No. 7 v' / Grave No.
(Signed) ' " `' -'
c--- (Person Ln 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.