Beakbane, Alfred r ,i
Form vs.Gt. 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 alter the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No..............s5.7..r.
Dist. No.4'S..Ir.P..,..County....... .. ...aA C.e4e, age ,? t/ .C" �G� %���.. . .... .................. .
4itY ( cit ,give street address)
Name of deceased
qq il "Lk Single, marrie , widowed, --��//
Sex�� ...Color/!'. .o:- divorced (write the word).../T Date of Deat ..I '') 4 7 19.. J
Age 7e. Years. 3 Months.... t-4— Days Birt lace
Cause of Death........ '., G�' r.: . .. ... .
Certificate was signed by , I. 1 . .. ...,,..,........................... ...:,, M-.D:
Address f �, 31042
Place of Burial (or I:.emoval).... ).. 1 � ,,G,�,( �!
(If body is t9etrryemporaray held, h in space later) p
Cemetery .41. .UI�I.G�t.. e -h,gr"A et.1„0.r1.Date of Burial. .rad 19..�1..'�..2
(If body Is to be temporarily held, till in space is r)
The Certificate of Death containing t e 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, don the b is ttl3LIGRANT A PERMIT
f' e) dress)
the to hold temporaril and. the body.
T ertaker person baying charge of or se) to remove,o�herwi- Jose: • [s h• •I)
Dated �.d 19...r (Signed) Ci ..ale -- ••
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State I ubect 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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Cri r.,
Form VS 67.
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER' S REQUEST TO DISINTER BODY
''See Special Administrative Regulation 1, subdivision 4, Relating' to the Trans-
portation of Dead bodies by Common Carriers, as printed on the back of TRANSIT
LABEL
N.B. Permission for disinterment mast 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
Alf r e d B. Beakbane
, who died in the* C t 7
(City, yital,e Town)
of Glens FaLlP on* Nov. 277 194'e3 , Sex
Color or race* white Age* 73 years, and Cause of Death*
Chronic myocarditis
NOW INTERRED IN Pine View 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 tgXelleobY car to
North River Cemetery
at North ifiver
(State fujirjalltigoan_ip be made If body) (Name of place os
•
(Signature of undertaker)
Dated June 7 19 44
Address 84 Warren q't.
License No. 1338
APPROVAL OF HEALTH OFFICER
Dist. No.
I HEREBY APPROVE above Request a recommend that Fermi i n be granted.
gnature of Zalth Officer)
—13atttt 4r 7 - 19L-pi _
"Instructions to Local Registrar: Fill out (a) T Permit for bodies trans-
ported by Common Carrier or (b) ordinary Offical 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. When data can not be obtained write "Unknown" in spaces in-
dicated by ( ).
The Disinterment blank should be filed and carefully preserved in your office.