Price, Emmy Form VS 61. 6-8-34-50,000 (17-7901)
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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No. Registered No.
Town
County Warren Village Ga,.a.li,ro u1. :S..x 7.14 f e
or City (If city,give street address)
Name of deceased ,Tr s. Emmy Price
Single,married,widowed, "
Sex married Color or divorced (write the word) Date of Death Feba22nd 19 3
Age 71 Years .a.. Months 2.7 Days Birthplace Plat tsburt,� a IT•Y.
g aerenary embolus
Cause of Death
Certificate was signed by Ise Re y S. Butler M.D.
Address GJ et .,9 Fa1lQ, 1:,Y,.
Place of Burial (or Removal) Fine View Cemetery Vault
(If body is to be temporarily held,fill in space later) ('Tau l t
Cemetery ��'=le ::� ..c�?, . ;..� v,Y. Date of Burial Feb. 25th 1 35
(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 examina-
tion, 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 HEREBY GRANT A PERMIT
to Harold C. Stafford Glens Falls , ±". .
Undertaker (Name) inter (Address)
the to hold temporarily ld the body.
(Undertaker or person having charge of corpse) emove,or otherwise dispose of[state how])
Dated.......Pnb... 2.5t.f 19 .3.5 (Signed) ,K
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.
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Form VS No. 67. 7-31-29-5000 (17-848)
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER ' S REQUEST TO DISINTER BODY
iie'"See Rule 4, Special Administrative Rules Relating to the Transportation
of Dead Bodies by Common Carriers, as printed on the back of TRANSIT LABEL.
N. B. If the disinterred body is not to be transported by a common carrier,
nevertheless this Request should be filled out and Permission for Disinterment
requested as below.
I HEREBY REQUEST PERMISSION TO DISINTER the dead body of
. 1 Price
, who died in the * city
(City,Village,Town)
of Gle.na__x a1ls_,N.Y. on * February 22nd, 1935 , Sex female
Color or race * , Age * 71 years, and Cause of Death *
corotlary___e4 Q2_1 NOW INTERRED IN -Pine View Cemetery Vault •
(a) The body is to be TRANSPORTED BY COMMON CARRIER for
at
(State fully the disposition to be made of body) (Name of place or cemetery)
(b) The body is NOT to be transported by Common Carrier but is to be transferred
e trN_e__I_Qr_--burial____at as. x r_1a___Ceus 4e_;`yr, SQ,.Glens ial1a
(State fully the disposition to be made of body) (Name of place or cemetery
on April 13th, 1935 /�
(Signature of undertaker) d �-•
Dated -ipril 4th 19 35 Address 219 Glen St., Glens
License No.
APPROVAL OF HEALTH OFFICER
Dist. No \
I HEREBY APPROVE above Request an recommend that Permission be grand.
(Signa of Health Officer) I�hex(
Dated rp4--i 9
agrInstructions to Local Registrar: Fill out (a) Transit Permit for bodies
transported by Common Carrier or (b) ordinary Official Burial (or Removal)
Permit for bodies not to be so transported, in each case writing the word
"DISINTERMENT" on the Permit. The data required concerning the decedent
may be filled in from the local register or cemetery record, writing "Unknown"
as indicated by (*) when the data can not be obtained.