Guthier, William vti
For, vs. 61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Lo:al 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, 6 0
Dist. No...J..6 l..County .7%f/� � - Village ss �� '
/��'r'� n �J (If c,.,give street address)
Name of deceased -!�/�- ��'L
Sex�li,, „ Single, married, widowed, • e c `
"'"""�Colo i'�or divorced (write t e word),Z "`� Date of Death �3 ....19�'3
Age ./O Y rs.. 4 Months / .Days Birthp c 4)'t- -'V.
Cr+use of Deat
Certificate was signe b �-�ti M.D.
Address .... . , • .
Place of Bu,ial (o emoval) �. s' ... -
(If body is to be ternr:ly he d,fll 1 space fate )
Cemetery.. t � Date of Burial / 104
(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 registrat' n av ec ed it in my Local Record with the above stated Registered
Number, and he b ' e I T A PERMIT4_�
to ,2.11* rX�,.
1`T es)
the to hold temporarily a .the body.
(Under r o erson havi j charge oi corpse) remove,or ote,Ise d e of[state wl)
Dated. ... ... . /� 194,,. . (Signed)
Local Reg stray
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State bject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) 's required.
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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 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
Willi.am...Jo.hn...Gu.th.rie , who died in the*. C.ity.
(City, Village, Town)
of Glens Fa?l.s on* Feb.....1.3,....1 , Sex male..,
Color or race* white , Age* 75years, and Cause of Death*_.Pulm.o.nary....tuberculos'
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 transported by
motor hearse for interment at Prospect Hill Cemetery, Argyle, N. Y.
(State fully the disposition to be made of body) ame of place or cemet
on /rip ' i y3 ,
(Signature of undertaker) `A41 ...
Dated....March. .22, 19..4..3. Address...2.2.1..Glen..St...,..rlans Falls.,. N. Y.
License No. 5302
APPROVAL OF HEALTH OFFICER
Dist. No.
I HEREBY APPROVE above Request and rec ' ' be granted.
(Signature of Heal Officer) !.`;&.'
Dated... .......".�L/t .
Instructions to Local Registrar: Fill out (a) Transit Permit for bodies trans-
ported by Common Carrier or (b) ordinary Of fical 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.