Aubrey, Archibald Form Vs.sL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
er Thk 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 Registered No—_`.}3........_
Village
Dist. No5726 County Washington or City Hudson Falls
(If city,give street address)
Name of deceased Archibald H. Aubrey Veteran no
Single, married, widowed, ([f veteran. Give name of War)
Sex ,m.T6 Color w or divorced (wte the wrd) married Date of Death nov, 5 1g...`$..
Age Years Months Days Birthplace Fort Ed><wer cl.,, ..11..,Y..
Cause of Death Coronary Thrombosis
Certificate was signed by C • v• Latimer M.D.
Address Hudson F01is,...J ..X...
Place of Burial (or Removal) Tn. of Queensbury,.,,• ,.. X„
(If body is to be temporarily held, in space later)
Cemetery View 11 7 Date of Burial / 8 19
(If body is to be temporarily held,till in space later)
Thn 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 registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to Joseph F. Re, ,an, Jr, Glens Falls, N. Y
u n d er t s.k eWame) (Address)
the to hold temporarily and inter the body.
(IIu dertaker r person having charge of corpse) (Inter,remove,or o a�nose of[state how])
Dated 1V oV. o, 1958 19 (Signed) .r _ n_ / . ,! ..P,.,,_ ..- L- _t •
Local R
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),ualess removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
c.J- cam-m
INDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR CREMATIONS
ARE MADE
Date 4l/..y1-.6 / 19C.5Z
(Interment or�f
(Name of Cemetery, Crematorium, etc.)
6-A
Section Lot No. Grave No.
(Sifined) �9",i6
k' rC� •
(Person in charge)
Addressf6� ✓/�
•
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 UNDERTAKER MUST SIGN ABOVE STATE-
MENT, 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 re-
quired, under penalty, to report violations thereof.