Bishop, Emily Form'VS. tiL 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. e'istered No. 1/
Town
Dist. Nb-u 4./.County . e /.tl1,ie t/ Village // 9 )1t
• or.Cit (If city,give str t address)
Name of deceased.. .. ... ... .. •
01 Ingle, marrie , widowed, •
Sex„. " �.. . Color IV or divorced (write the word). Date of D•.th.�4// /. 1.9..ftg
Age Jk L... ' Ye s.... ...6. Months ./../ ays Birth lace.. ..
P r
Cause of Death W
Certificate was igned by i-4•4_i M.D.
Address .4'.. .. a!-ee-t� ...7-GC ,
Place of au lal (or Removal) - - �wC,{ y /f/.0
(If body is to be temporar:ly held,fill in space later)
Cemetery.. .... Date of Burial::.. ily 19...04
(If body is to be temporarily held,fill in apace later)
The Certificate of Death containing the above stated particulars, having been presented to e, 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 th blsis th f I H REB GRANT A PERMIT
Name) ddress)
the to hold temporari y t body.
( - ertaker or person baying charge of corpse) (I m ,or otherwiesno
Dated. ... ......19..44,5 (Signed)...
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 re4uired.
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Form VS 67.
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER ' S REQUEST TO DISINTER BODY
L= 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 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
Emily..Geo.rg,.tne B.i..sho.p , who died in the* CI
-tY.
(City, Village, Town)
of Glens Falls on*. ..Jan,..7',,...1.94 - , Sex Femwle ,
Color or race* white , Age*. .....79years, and Cause of Death*.H cci.dent-.frncture of
skull
NOW INTERRED IN..P.in.e.. iew..0.em.et.e.ry...V.auit
(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 --- rt 7C �;i'
mono„ hear.F.p... o.r.. ��t.ermen•t at..Pr.osp- t...H .ii...cemete .y.,...S1 dney.,. N. Y.
on �t(State f ly thg p°;ition to be made of body) (Name of place or cem
Y. '� f dJ_`Lr
(Signature of undertaker) s - ed- i / `62
Dated March 22nd, 19...4.3. Address.22.1.. 1en..Bt...,...G1ens...F.all.s.,..Sv. . .
License No. 5.30.2
APPROVAL OF HEALTH OFFICER
Dist. No.
I HEREBY APPROVE above Request and recorr>‘end_t t Perini ion b g armed.
(Sign tune of Heal Officer) ��
Dated.. ..... �./. .�� .-...19
1/
" Instructions to Local Registrar: Fill out (a) Transit 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.