Brundage, Rachel NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
iSr 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. 10
Registered No.
Town, Villa
Dist. No. 5725 County Washington or City -Tillage of Granville
If city wive street address)
Name of deceased Rachel G. Brundage Veteran 1I\
o
(If veteran,give name of War)
Female •
Single,married,widowed, P�ever Morrie 07/14/79
Sex or divorced (write the word) ate of Death 19
Age 74 Years Months Days Birthplace New...York..State
Cause of DeathCenitral__Nerouus___System__Depression_,tIremia...and__.Septic.emia
Certificate was signed by Jay...Edison, M.D.
Address 140___Broadway.,_.Whi-tehall,.__New...York
Place of Burial (or Removal) _..Town of of Queensbury-, New York
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Cemetery Date of Burial 07117/79 19
(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 Reran & Denny Inc. , Quaker Road, Glens Flls, New York
(Name) (Address)
the John_._J-._---Ro-ss to hold temporarily and �. __ .___.__. _Bt ria. ..._,. t dy
(Unlertaker or person having charge of corpse) r ove, r is of ( e ho
Dated July 16.,___1979-- 19 (Signed) ..
Local Registrar
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)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date ` 4-1.-1 .-s-'- was 1 i 19
(Interment or
„ECe„..7.Lt KT I ,
(Name of Cemetery,
//��//
Section 67 `a Lot No. '.X, Grave No. /
(Signed)
(Person in Charge)
e.Address r -��' `":
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.