Hendy, Seretha 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. .1)a.
�,
Town, Village
Dist. No. 560 County Warren or City Town of Queensbury
Seretha L. If c' give street address)
Name of deceased Hendy Veteran No
(If veteran, give name of War)
Female Single, married,widowed, .'iidowed Dec.Sex or divorced (write the word) Date of Death 14 19�9
Age 72 Years Months Days Birthplace ___New_.York._.S.tate
Cause of Death Myocardial Infarction
Certificate was signed by .. Robert A. Reid M.D
Address 8 Harrison Ave. ,Glens Falls, N,Y.
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to be temporarily held, fill in
space later) •
Cemetery Pine View Cemetery Date of Burial Dec. 14 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 Rd. ,Glens Falls, N.Y.
(Name) (Address
the Undertaker to hold temporarily and _ .;_.__..I Inter the Body
(Unlertaker or person ng charge of corpse) nt ,, re ove, or other 1;, di se of ( tate how))
Dated — /F r 19Zp. (Signed)
Local I stray
This Permit 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) 18A2-781
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of t`L%rzyi-cam as A-4/1..//9 19
(Inntterment or Cremation)
(Name of Cemetery,
Section Lot No. 1.3 6" Grave No. /
(Signed)
erson 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.