Frair, Minnie Form VS-ni (rev. 11 651 •
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY
In completing this form, please typewrite, hand-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.)
Minnie L. Frair Female .75 yrs.
lace of Death iindicate ,-=tether city, v,t1a,e or to vo) Date of Death Cause of Death
`,Test Braintree, Mass, 3-27-70
Cemetery now interred .ocation (city,town or county) Is body to be transported by common carrier?
Pine View Cem. (vault ) Queensbury N.Y. • p Yes ce No
State fully the final disposition to he made of body.
Internment in Family Cemetery
!Same of place or cemetery for final disposition Date of final disposition
Maple Hill Cemetery, Rouses Point,N.Y. 6-10-70
t irc Nai4'e Reg. No. Address Regan 1 Denny Funeral SgFv. D-3152 341 Glen St. , Glens Falls, N.Y..
- --- - -
8 }'u rat G —to'r// Reg.00296
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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. I be data required concerning the decedent he obtained from the local register or cemcicry 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.
`- * NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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.
3'Dist. No. / County . "✓..lf-�� e-3-G-/ or City &r -.3 \7 4--`
(If city, give street address)
Name of deceased .... 1rrt-tT 2:12, , C—e-e=e--✓)-en•-' Veteran
(If veteran, give name of War)
�A Single, married, widowed, l,_,
Sex vv1C�Lc—, or divorced (write the word) .../."' Q-y•)-2�• Date of Deathl" e 4-, c".1.1 .19 .711
Age 7 7 Years//, .Months Days Birthplace i_.�-v-pry&
Cause of Death !/fye/a2L (-
Certificate was signed by .;e, .:../✓ .a-4": M.D.
Address -. . : er.1r:. �j G �(�
Place of Burial pRemoval) t 1 � „�-- /
(If body is to b� oraril - held, fill•in space ter)
Cemetery (... �,,,<,.U4---dew. Date of Burial , c;'n 3.% 19.7d
(If body is Co be temporari y held, 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 m , Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIylk fJ /f� "
toG�G1ifZ- r(:' Na'l� -�id '; ✓ -, G,9
( e) (Addr s)
the / z Z - 4 to hold temporarily and the body
(Underta•e or person having charge of corpse) (Inter, remove, or otherwise ispose of (state how))
Dated L . 19 r.�.�.G (Signed)C .. ".(�e..('�� �•. -5 ..z-..
e�/7�L.U, e • ar
This mit is sufficient for the Removal (and Interment or Cremation)of a iodyt any part of t e S e (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. 6/631 (9A2-205) 91
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of r f)yz- 4-1`"LL` was // 7 19
(Interment oc.Gremeeion.)-- .
(Name of Cemetery,
Section Y '( Lot No. Grave No.
(Signed
(Person in Charge)
Address
2 r�
Perso ' charge must return this Permit to the Re strar
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.