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Mc Cabe, Victoria z NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT t' 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. Town, Village Registered No. T 7`-- Dist. No. S'L 01 County Is1 .._.. or City - -s -- .- - a.__ (If city, give street address) Name of deceased ...) C-°---,r,t,.,`S—". Veteran (If veteran, give name of War) Single, married, widowed, " Sex es„-r- CL-L or divorced (write the word) Date of Death a--1i- 19 ..`7 D Age 7 O Years Months Days Birthplace . . Cause of Death .. .. r Q Certificate was signed by t..-- - -4.-V- — M.D. Address-------`--%-- - Place of Burial (or Removal)j e.., ,,,,._ -$ (If body is toh m p e teporarily held, fill in space Ia r) Cemetery .....- ne,-�3..,....... • .r— Date of Burial A— i°) — 19 '1.(), (If body is to be temporarily held, fill in space later) The CERTIFICATE OF DEATH containing the above s4-d particulars, having been presented to me, after careful examination, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra• tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A PERMIT to --,v. .=+-,.....- 4-- - —4- i'- (Name) (Address) the " 4..r...,,," to hold temporarily and the body (Underta-er or person having char of corpse) (Inter, r ve, or of a wise pos 'bf f;fate how)) Dated .. 1� 1 t - 19 q tZ (Signed) 'Ccl�-d� � ocal fl'egistrar This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any pa 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. FORM VS. 61. (REV. 6/63) (9A2-205) 9) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE �1 r Date off `" ZFirc was C� v /7 19 '7G (Interment or(Name of Cemetery, GremateritrffreTET Section Lot No. Grave No. (Sign d� n d e) L 7t �' (Person in Charge) Address /}j Person in ch arge must return thist to t he gRegis ra of his District within SEVEN (7) DAYS from above date. Ifno person is in charge, the FUNERAL DIRECTOR or UNDER- TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit the words "No person in charge," and FILE PERMIT WITHIN THREE (3) DAYS with the Registrar of District in which cemetery is located. SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Registrars are required, under penalty, to report violations thereof. — r NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT Q 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. Town, Village Registered No. Dist. No. ..; J...7 County t�'YYe+�-- or City ( ^^-tu„_"� (If city, give str address) Name of deceased J,t.; 'v'�p1. Cv- -- Veteran (If veteran, give name of War) � Single, married, widowed, Sex !1 ,,,.,.-,Ya or divorced (write the word) Date of Death a o iY 19 7 kl Age ?© Years Months Days Birthplace Cause of Death Certificate was signed by . M.D. Address Place of Burial (or Remova Gtv-0D •I'l !J , (If body is to be temporarily he d, fill in space later) O Cemetery Sv. ` 1 - ,� Vim-- ��r Date of Burial y— 19 7 (If body is to he temporarily eld, fill in space later The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra- tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A PERMIT �J p Pt- . to J�h n-ly)-_ 3 ( - L`°/ ^.L/tl i c-i., -' ff// (Name) (Address) the 'V'-4 to hold temporarily and the body (Undertaker o person having charge of corpse) (Inter, remove, or otherwise dispose of (state how)) Dated 19770 (Signed) 4. 0 C44+m- 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. FORM VS. 61- (REV. 6/63) )3A2-323) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of 'was 7//11' 19 77-9 (Interment op,c,r-€44.1.t.j.Q.14.)-7 (Name of Cemetei Section Lot No. Grave No. (Signed) /" (Person in Charge) iet Address Person in r e must return this Permit to the Re iistr g g of his District within SEVEN (7) DAYS from above date. If no person is in charge, the FUNERAL DIRECTOR or UNDER- TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit the words "No person in charge," and FILE PERMIT WITHIN THREE (3) DAYS with the Registrar of District in which cemetery is located. SEXTONS, FUNERAL DIRECTORS and UNDERTAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Registrars are required, under penalty, to report violations thereof. a - Form VS-67 (rev. 7763) NEW YORK STATE DEPARTMENT OF HEALTH Office of Vital Records FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY In completing this form, please typewrite, band-print or write legibly all entries in permanent black or blue black ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN" in applicable spaces. I hereby request permission to disinter the dead body of: Name of Deceased []Male Age(yrs.) Miss Victoria Mary McCabe Female 70 Place of Death (indicate whether city,village or town) Date of Death Cause of Death Glens Falls Hospital 2-1 4-Z0 !: . V_ A _ Cemetery now interred Location(city,town or county) Is body to be transported by common carrier? Fine View (vault) own of Queensbury E Yes RD No State fully the final disposition to be made of body. Burial Seelye Cemetery Nathe of place or cemetery for final disposition Date of final disposition Seelye Cemetery Town of Queensbury, NY 4-8-70 Firm Name Reg.No. Address Regan' Deny c . D3081 341 Glen St. Glens Falls, NY 1Signature off ner irector o 'tnde er Reg. No. Date t LZ G 00348 4-8-70 APPROVAL OF HEALTH OFFICER i hereby approve the above request and recommend that permission be granted. Dist. No. Signature of Health Officer Date !INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER: 1. See Section 13.1 (formerly Chapter XIII, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies by common carriers, as printed on the back of the Transit Label. 2. Permission for disinterment must always be obtained whether the body to be disinterred is to be transported by common carrier or by other means. 3. The data required concerning the decedent may be obtained from the local register or cemetery record. INSTRUCTIONS TO LOCAL REGISTRAR: 1. For bodies to be transported by common carrier, fill out Transit Permit. 2. For bodies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit., 3. In each case write the word "DISINTERMENT" on the Permit. 4. This form should be filed and carefully preserved in your office.