Tromblee, Warren NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ggr 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. 394
Dist. No. (98 County A I bany or City Albany
(If city, give street address)
Name of deceased Warren M, Tromb lee Veteran WW I I
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced(write the word) Married Date of Death 10/18 19 74
Age 54 Years Months Days Birthplace New York
Cause of Death Card I o—resp I ratory arrest
Certificate was signed by I rena Hreben I ak M.D.
Address VA Hospital , Albany, New York
Place of Burial (or Removal)(Oar pf,.Qu ens.k?u.ry., New York
(If body is to be temporarily he d, (ill in space later)
Cemetery n±7:*.t ottatts- Rine View Date of Burial 10/ 19 74
(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 Quaker St. , Glens Falls, New York
to Reagan & Denny Funeral Service,. Inc.
(Name) (Address)
the Undertaker to hold tempor- :ly . d Inter the body
(Undertaker or person havingcharge of corpse) (Inter, remov ql h., erwtse 4is se.of (state how))
Dated l 01$ 19 74 Si(Signed) 4 -'.a,.,.,‹. �
1.1
( g ) Loca Registrar
This Permit is sufficient for the Removal (and Interment or Crem tion of a body to any part of the State (st ijrect to local cemetery or
other regulations), unless removal is by common carrier, in which • se = Transit Permit(VS No. 62) is required.
FOILM vs. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of i` !'Ifl;"V Pf Li - was 19/
(Interment or Cremaqion)
(1 )
(Name of Cemetery, Erem n, a?c
Section Lot No. r Grave No.
(Signed) /'` 1"���
/ (Person in Charge)
Address
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.