Sluyter, John NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
(Gr 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, Vi 1 e Registered No. 225
Dist. No. INCounty Abbany or City I I Holland Avenue, Albany, New York
(If city, give street address)
Name of deceased John...S.l.uyter VeteraWW I
(If veteran, give name of War)
Single, married, widowed,
Sex Ma i e or divorced (write the word) Single Date of Death 6/22 19 70
Age 83 Years Months Days Birthplace Hot land
Cause of Death Bronchopneumonia, acute,. bi lateral
Certificate was signed by Noah...Robbins M.D.
Address ...VA Hospital..,. 1 13 Hol land Avenue, Albany, New York
Place of Burial (or Removal TPwr�...of•••Ruefnabury., NY
(If body is •to bet porarily he d, fi in space ter
Cemetery Fine View Date of Burial 6/26 19 70
(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 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 Regan...i..Denny�NFun)ens.l....Service.,....Inc.... 341...Glen...St..,....G.1.en.S Fa.l Is, SNew York
amethe Undertaker to hold temporarily and Inter the body
r
(Undertaker or person having charge of corpse) �'�(Inter�r ve, oho` eryvr�e dispose of (state how))
Dated 6/2419 .,.7.0 (Signed)C,1 c-6;-.. � -y° -e
I ocal Registr r7'`-
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to"any part of the State'Tsubject 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 oiz�-' � was Gam-"e
(Interment mr •
(Name of Cemeter , 6rcraetoriam, cte.)
Section Lot No. % ` 4rave No.
(Signed)
(Person ih Charge)
Address
Person in charge must ret rn this Permit to the Regis�Efar
of his District within SEVEN 7) DAYS from above date. If no
person is in charge, the FU ERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE TATEMENT, write across the
face of the Permit the word "No person in charge," and
FILE PERMIT WITHIN THREE (3) DAYS with the Registrar
of District in which cemetery is located.
SEXTONS, FUNERAL DIECTORS 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 FOB THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.