Legault, Leonie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Or 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. ///
momageiltbmie
Dist. No. ____5601. County '.jarr-eti or City Glen& -- €fl—(9
If city, give street address)
Name of deceased Leonie L Le- auJ..t Veteran no
(If veteran,give name of War)
female Single,married,widowed,
Sex or divorced (write the word) widow liar of Death liar19 80
Age 81 Years _... _. __.._. .__ Months-___ Days Birth lace Cheney, Ont€� 10, C=n ea
Z::i:tr:t?signedby
� �_.LU/►�I- - - Co._. ._..- i!x�H-t-'iti c� M
Address �-
Place of Burial (or Removal) in of (.ueens bury, NY
(If body is to be temporarily held, fill in space later)
Cemetery 9t '.lphonsus Ce.rrlo tery Date of Burial T;_tar 11 19 80
(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 Funeral Home, Inc. Hud son Falls , ITV
(Name) (Address)
the funeral---director to hold temporarily and int the body
(Unlertak r person hav• g charge of corpse) (In er, remo or o e wise dispose of (state how))
et_te
Dated id 19Z4•. (Signed)'1
Local egistrar��^�
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the-S£ate (subject to local
cemetery or other regulations),unless removal is by common ca•rier, in which case a Transit Permit (VS No. 62) is required.
FORM VS. 61. (REV. 6/63> (8A2-78)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of Interment was 4--9— 19$-
(Interment or Cremation)
St. Alphonsus Cemetery
(Name of Cemetery, Crematorium, etc.)
Section I Lot No. T 3 Grave No. 7
(Signed)
IP son in Charge)
Address 35 Broad St. , POBox 600,Glens Falla,NY
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.