Howard, Mary / ( 1' 7 - Y e
Form VS.sn NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
12r 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. Registered No..._t .____..__...
TowDist. No 5601 County Warren Village 51 Warren St.,Glens Falls,I�TeY
or City (If city,give street address)
Name of deceased Mary:...E.....H.QWaX:d
,Single, married, widowed, widowed Feb1$ 9 Ser Femalecolor whit or divorc d (write the wrd) Date of Death , 19. e�...
Age 94 Years 7 Months 4 Days Birthplace Windsor,...`;tt...
Cause of Death 1 ,y.R.Q.ax'ditiar.S...yra« .a.r..iso...s.eleraai.a�r10...yra..:,...Artl r••iti�aa-la• yr.s•.:••••
Certificate was signed by George M. �,sey_ _ __ _- __- M.D.
Hudson?ddress '#�,1�..s,,,. j,.•. y„
Place .f Burial (or Removal) Eine...Ltd ew. .Ce.R0.8.te.1.'.art....TP.,. 3 ...Qt..ill+iael ab>rt..,...I1ta...Y.•
(If bod:is to be temporarily held,fill in space later)
Cemetery Pi PQ V .8w...ae.Iaet.err Date of Burial FQb......20., 19....39
(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 exami-
nation, 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 Seward T. Potter 1.0.0 ..k'alla...I .,...Y.
Und e r te� (Address)
the to hold tempora ' r the body.
(Undertaker_or Person having charge of corpse) ove, r o ilpse of[state how))
Dated Feb r 20, 19.. 9.. (Signed
Local Registrar
This Permit is sufr^ient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regu. ions),unless remeaal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
to
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Form VS No.67. 9-16-30-5000 (17-1827)
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER'S REQUEST TO DISINTER BODY
nrSee 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. Permission for Disinterment must ALWAYS be obtained whether
the Body disinterred is to be transported by Common Carrier or by other means.
I HEREBY REQUEST PERMISSION TO DISINTER the dead body of
Mary E. HowardCity
,_who died in the *
(Cit Village.Town)
of Glens Falls on* Feb. 18, 1939 Sex Female
Color or race* White , Age* 94 .years, and Cause of Death*
Myooarditis NOW INTERRED IN Pine View Cemetery Vault
(a) The body is to be TRANSPORTED BY CO VIMONi le
CARRIER for
burial u omo
at Windsor Cemetery, Windsor, Vt.
(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
bury Windsor Vemetery, Windsor, Vt.
(Signature of undertaker) 1a' -
Dated April 251 19 39 Address 84 Warren St. , Glens Falls,N.Y.
License No. 1338
APPROVAL OF HEA H OFFICER
Dist. No
I HEREBY APPROVE above Request an. - • • hat,rmission be granted.
(Signa of Health.Officer) • t .! ---
Dated___ . ' 19 `T
IR-In s truc tion s 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.
The Disinterment blank should be filed and carefully preserved in your office.