Trombly, James NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
jam` 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. 284
Dist. No. 196 County Albany or City 113 Holland Avenue, Albany,NY
(If city, give street address)
Name of deceased James F. Trombly Veteran WW 1
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death 7/24 19 73
Age 77 Years Months Days Birthplace Canada
Cause of Death Bronchopneumonia
Certificate was signed by M. Chaudhry M.D.
Address VA Hospital, Albany, New York
Place of Burial (or .Y..
Removal) (,.I.eris•.Fa..1.1.S,...N:e�t.. ork
(If body is to be temporarily Ah�id, fill in spacelater) 7�27 73
Cemetery St. phOnSUS Date of Burial 19
(If body is to he 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 Wm. J. Burke & Sons Broadway, Saratoga Springs, New York
to
(Name) (Address)
the Undertaker Inter
to hold temporari d the body
Dated(Undertaker or person havi�pv�hargelo corpp) Inter, remove or rwtse d'is os of (state how))
// 44 (Signed) ::,t'...,,:i e _e;.
`Local Registrar
This Permit is sufficient for the Removal (and Interment or Crem ion)o a body to any part of the State (su o local cemetery or
other regulations), unless removal is by common carrier, in which sea ransit Permit (VS No. 62) is required.
FORM VS. 61. (REV. 6/63) (A2-248) .
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date ofC was t. . .., b 1973
(Interment or Cre i
LY /t141
(Name of Cemd42) o
, Crematorium, etc.)
Section a Lot No _Grave No. CJ
(Signed)
erson in Charge)
Address 3$ it 11.24 r
Person in charge must return this Permit to the Registrar
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.