Hoag, Eva 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.
60 Town, Village
Dist. No. County -� or City f ,1 a t C
// If ity, giv street address)
Name of deceased 14'a !TO aL Veteran /0
(If veteran, give name of War)
r Single,married,widowed, /
Sex t e ✓N 4 I e- or divorced
nt(write the word) ` t_h j_!�- Date of Death-Pedern b er. /k _ 1929. -_
Age F3 Year .‘2Mom 1' No l Da ,�.� ,;c,�,Q u��,," f °ZCause of Death ti( � ' , AA.,
Certificate was signed by • B. 5 h a , r M.D.
Address /Z13 Coz../--f St• , Uf, 'e4, NAy.
Place of Burial (or Removal) South Glens Falls, N• Y.•
(If body is to be temporarily held, fill in space later)
Cemetery S_t.__Alphonsus Cemetery Date of Burial.._Dec_.___22 19.7.9___
(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 Martin J. Nunn Funeral Home, Inc, 13,.oiae,__NA__X_.
(Name) (Address)
the Undertaker to hold temporarily and Inter the body
(Unlertaker or person having charge of corpse) (Int remove, ort erwisAe dispose of (state how))
Dated__December___1B 19___.79 (Signed) Q c�r Z fi�-�
ee'�Ct 6 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) (6A2-130)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of Interment was 5 - 20 - i 0
(Interment or Cremation)
St. Alphonsus Cemetery
(Name of Cemetery, Crematorium, etc.)
Section II Lot No. 23 — I Grave No. 10
(Signed)
(Person in Charge)
Address 35 Broad St Glen3 Fa113, 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.