Morey, Frederick NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tgr 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.
Re ' tered o.
Town, Village
Dist. No. ....56-6)1 County 4)Name of deceased or City
(If city2,t ive streetiadless)
(7?--- 2 . /
(If veteran, give name of War)
Sex ..... ede____
-••— •-•-
(77)Z2 Single, married, widowed, Veteran ' 27
or divorced (write the word) (
Date of Dept3i :9-... je 19
Age t Years onths Days Birthplace ' ( - .--- ..
Cause of Death 0 /4
Certificate was signed by M.D.
Address ZOIC/U ?-3cAP-- 7/ '
Place of Buri (or 13err.loy1)_.,...,,,..,
p
(If body is to e emporari,09 eld, till n 42a9C-eliet-Th" 'Al-f2i-Ift"2"6U1'6447,
Cemetery Date of Burial 19
(If body is to e 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 Nu ber, and on the basis thereof I HEREBY GRANT A
P E R M IR
- <7(to ,..---(/0-44-i-, (Nanc....rd s.4.4.4,1 • bcti.„.._
q -,.. ( a. ress
the to hold temporarily the body
(Underta e or persorejiaving charge of c,prpse) nter, reyle, oxicreieutspose of (state how))
Dated
t-- 19 'Itt (Signed)
"i'" Locz;„,Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a bod to any part of L.,- State (subject 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) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date oft i2Z 1l<< �� was } r , Ig 7
(Interment or _ )-
l c C
(Name of Cemetery,Cremarorium. etc.)
Section , l`�L��G Lot No. Grave Nc
(Signed) 1 i, (�, / / i L ,
(Person in Charge)
//
Address , <� f >>
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above date.'Ifno
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.
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Form VS-67 (rev. 11/65)
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY
In completing this form, please typewrite, hand-print or write legibly all entries in permanent black or blue black
ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN"
in applicable spaces.
i hereby request permission to disinter the dead body of:
Name of Deceased ID Male Age(yrs.)
Frederick N. More 0 Female 71
Place of Death (indicate whether city, village or town) Date of Death Cause of Death
City of Glens Falls. New York 1/6/74 Cancer
Cemetery now interred Location (city,town or county) Is body to be transported by common carrier?
Pine View Vault Town of Queensbury, N.Y. ❑ Yes NI No
State fully the final disposition to be made of body.
BURIAL — PROSPECT HILL CEMETERY, SCHUYL.RVILLE, NEW YORK
Kahle of place or cemetery for final disposition Date of final disposition
Prospect Hill Cemetery, Sc.huylerville, N.Y. 5/7/74
Firm Name Reg. No. Address
Regan &Benny, Inc. 02883 Quaker Rd. ,Glens Falls, N.Y. 12801
Signature or I tte al Pir for or U dertgk 'Reg. No. Date
04794 5/6/74
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INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER:
1. See Section 13.1 (formerly Chapter XIII, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies
by common carriers, as printed on the back of the Transit Label.
2. The data required concerning the decedent may be obtained from the local register or cemetery record.
INSTRUCTIONS TO LOCAL REGISTRAR:
1. For bodies to be transported by common carrier, fill out Transit Permit.
2. For bodies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit.
3. In each case write the word "DISINTERMENT" on the Permit.
4. This form should be filed and carefully preserved in your office.
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