Dingman Jr., Eldoras NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
nr 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.
Dist. No. 5501 County Ulster oar City Kingston
If city, give street address)
Name of deceased ELDORAS DINGMAN JR. Veteran W W II
(If veteran, give name of War)
M Single, married,widowed, Married Sept. 27 79
Sex or divorced (write the word) Date of Death 19
Age 68 Years Months Days Birthplace N.Y.S.
Cause of Death Peronitis
Certificate was signed by David S. Gerbarg M.D.
Address Kingston, N. Y.
Place of Burial (or Removal) Glens Falls, N. Y.
(If body is to be temporarily held, fill in space later)
'Cemetery Pine View Cemetery Date of Burial Sept. 29 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 Frank H. Simpson Funeral Home, Inc. Kingston, N. Y.
(Name) (Address)
the Frank H. Simpson to hold temporarily an inter .__ the body
(Unlertaker or person having charge of corpse) nt remove, o w'. is °r' o if,;.te how))
/
Dated _ .Sept. 28 19 79 (Signed) . . . __
Local e istrar
This Permit is sufficient for the Removal (and Interment or Cremat' ) of a body to any part of the St (subject to local
cemetery or other regulations), unless removal is by common carrier, in w ich case a Transit Permit (VS No. .2) is required.
FORM VS. 61. (REV. 6/631 I8A2-781
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of.j-) r wa was _2/24 19 2!
(Interment or Cremation)
(Name of Cemetery, Crernaiednm„a c3
Section 4;44A 6 - of No. 3 Grave No.
(Signed)
(Person in Charge)
Address e Gam- /� "'
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.