Fisher, Charmaine 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.
Town, Village
Dist. No. �C) County__ • C.,-\S\-\ or City 14p
(� f city,f lve street address)
Name of deceased � V 1 ._ .�r1� V:t an 1v
eteran, give name of War)
Si gle, marl , idowed,
Sex _._________ _C QO or ivorced ( it the ord \ Date of each �_\ D3 1934
Age _ __ rs M nth lays Birthplace t
Cau - . • •• h
Ce ' icate was sign d by M.D.
Add ess_ _,
Place e, Buri• (or emoval) ti._U vaN•3 CW/•%-..' �„ `4 QCgQ9x`--"(---
(If body i. tfAe •mporarjly held, fit n space later)
'Cemete , .• 0_J? Date of Burial _ 19--?)
(If body is(to b- temporarily held, fill in space later)
The CER . 'ICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,
the same .spearing 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 __.S US �� .Nn s�. ?St7
(Name) (Address)
the Wkkq��--- to hold temporarily and _6/"--) the body
(Unle aker or pecItton
1 having charge of cor seg� (Inter, remo or otherwise dispose of (state how))
Dated 19 .).. (Signed) _.._\`fll 5 �` .
7 al Registrar
This rmit 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. 6/631 (8A2-78)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
� o `
Date of was 7 A 19 I/
(Interment or
(Name of Cemetery,
Section C4t-4"fA"-4Lot No. 5 Grave No. 7
(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.
FISHER
(J4!) 155,156,157,
Lot No. 161,162,175
Address 2 Garner St., Glens Falls, N.Y. Section NO
Owner James G. fisher Sr..& Peggy J. Fisher Plot
Oneida
Date. 7/27/77
600 Superficial ft. @ $2.50 per sq. ft.
Location Bounded on the North by Path, East by Path, South by Savale,Bowman, Fitzgibbon, West by
Road, savale & Bowman
Corner Posts
Remarks The Deed listed below replaces Deeds #1408 & 11416 which have been voided.
Deed No. (and changes) .1)1}i5
Payment Record Paid in full 7/27/77
p ,
Form No. 01
Record of Interments
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FISHER, Charmaine
= Stilborn
q;-"!
Clow Unknown
•Let Ores: James fisher
Let • 156, Oneida Plot
Ossirrt 1 7
Cam Styrofoam
Died: 9/23/54
7/25/79
ftdeptibies Sullivan & Minahan
This body removed from Glens Falls Cemetery
7/25/79.