Price, Mabel 1111111r
ate' Florida • Department of Health and Rehabilitative Services • Division of Health
Burial Permit No A 3
BURIAL-TRANSIT PERMIT
Full name of deceased .)1a1/2. 1eA .79 it..4.t..,.?
Place of death F044.42.1 Florida
atiaweje:4444-?( ity) co ty)
Date of death 21141=V le, .19 7-5- Color. LU-14P1 Sex. (aid Age 7,
Method of disposal P4rigt.111AL
( urWhether b Jai, ere ation, transportation, storage, e .) (Cem tery or Cre tory)
County Stater
lierOc t of d ath ha ing been filed as required by the Vs of th* State, permission is hereby given
to License No
(Funeral firector or person acting as such)
to dispose of I1.dy of said deceased as above stated.
Date issued'''... -eo %-2-4, M7-1, Signature tx A-1242g'
( egistr ?
OR CREMATORY AUTHORITY SHALL OUT SPAC.E. BELOW
Body was = on 71.(`-(-.' --'" 19;7N,—in
State whe) er cre ated, buried,stored, etc.) emetery ---_,.
Place ( e-0- 7V ' . -d-KA-ti Signature.. --,
- (Sex n or person in charge)
V.S.#640
This permit must be endorsed by the Sexton (or by the Fun al Di ector where there is no sexton) and re-
turned within 10 days to the Registrar of the district in which the ial takes place.
if' L•lit
.- 44. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
air This Permit can be signed only by the Local Registrar (Deputy cc subregistrar) of the Primary Registration District (Town,
Vilrage, 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.
Dist. No. 5.(e.6-7 County or City ?'.4.p.
' (I city, give street address)
Name of deceased C)-10..\'-o.g..t,..,. r :C.. Veteran
(If veteran, give name of War)
Single, married, idowed,
Sex Pe,—q•-\-•47... or divor d e the word) Date of Death ...- --.2 C. — 19 2. ---
Age /7 r? Years ..M n Days Birthplace
Cause of Death iVe.r.4 -,+ ck-4-21.-p.... .
Certificate was signed by v M.D.
Address
Place of Burial (or Re o : ii-c•,.,, ge, , V4 , i--4-
(If body is to be tempora • he ili•• n space later) •
Cemetery .....e. T.r....:.e....3 4 e(If body is to be temporarily held .
ill spae ter
c i.e..e • /.),/ Date of Burial 5—..F— 19..2s1.
in ra )
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
PERMI
to IC "`Lgt.n.. -4 ie-s.te.1.-411... -% `4""-' Q 4e csice- R ci 4 4..erA , Z.-2"-A- , •-t) --At
(Nartiet daress)
the Li,, K.t..e.—\--INY-.e e to hold temporarily and ..--4=t7....., .. e_. the body
(Undertaker oterson having charge of corpse) ( t r, remove, or otherw dispose w))
Dated .".".,/ — 19 -7,5 (Signed)
Local Regg7r=
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), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM vs. 61. (11.1.:V. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date o %�'1 i// was ' 19 74
(Interment or Cremaattion)
(Name of Cemetery, ~
Section Lot No. Grave No.
(Signed)
(Person in Charge)
Address le
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.
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 Male Age(yrs.)
Mabel Price Female 77
Place of Death (indicate whether city, village or town) Date of Death Cause of Death
Zephyrhill, Fla. 2/26/75 Heart attack
Cemetery now interred Location (city,town or county) Is body to be transported by common carrier?
Pine View Rec. Vault Tn of Queensbury, NY 0 Yea RI No
State fully the final disposition to be made of body.
Internment — Friends Cemetery, Town of Queensbury, N.Y.
Name of place or cemetery for final disposition Date of final disposition
Friends Cemetery, Tn of Queensbury, NY 5/9/75
Firm Name Reg. No. Address
Regan & Denny,, Inc. 02883 Quaker Rd. , Glens Falls, N.Y.
9ignainva of Funera dire or or Uncle er////// — ,Reg. No. Date
04794 5/1/75
•
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.
-A.