Whitcomb, Raymond NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rar 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. 242
Dist. No. 198 County A I bany or City A l bany
(If city, give street address)
Name of deceased Ra.yrnon.d...D.....Ali.tomb Veteran WV 1 1
(If veteran, give name of War)
Single, married, widowed, Married 6/20 74
Sex Male or divorced (write the word) Date of Death 19
Age 53 Years .Months Days Birthplace New York
Cause of Death Congestion, lungs, bilateral
Certificate was signed by I rena Hreben i ak M.-Et:—
Address VA Hospital , 113 Holland Avenue, Albany, New York
Place of Burial (or Removal) Town of Queensbury, New York
(If body is to be.tenpoUtilynS �a(111 In space later) 6/25 74
Cemetery west 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 Densmore Funeral Home 7 Sherman Avenue, Corinth, New York
to
(Name) (Address)
the Undertaker to hold tempo 'ly and I t9r the body
(Undertaker or person having charge of corpse) (Inter, remove o4alRegigtrar
rwise dispos of (state how))
Dated U.L.21 19 74 (Signed) . 04.2.. / . : :1 Z. .
This Permit is sufficient for the Removal (and Interment or Crema on) f a bo y to any part of the State (subj o local cemetery or
other regulations), unless removal is by common carrier, in which c se 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 WI-UCH INTERMENTS OR
CREMATIONS ARE MADE
,,,Date oa 6 A"-vu✓)- s L a-5:.9,
(Interment or C w)
(Name of Cemetery J. mesariij ., tF)
Section Lot
-...... No. Grave No.
(Signed) 1.4.�( i -z _yam mac.
(Personln Charge)
I
r
Address
Person in charge must re umthis Permit to the Registrar
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 STATEMENT, write across the
face of the Permit the wor s "No person in charge," and
FILE PERMIT WITHIN THR E (3) DAYS with the Registrar
of District in which cemete is located.
•
SEXTONS, FUNERAL 0 RECTORS and UNDERTAKERS
violating the law relative to t e return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS F R THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations hereof.