West, Arthur NEW YORK STATE DEPARTMENT OF NEALTN `
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed oely by the Local Registrar (Deputy or 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. 281
Dist. No. 198 County Albany or City Albany
(If city, give street address)
•
Name of deceased Arthur P. West Veteran WW II
(If veteran, give name of War)
Male Single, married, widowed, Married 8/1/75
Sex or divorced (write the word) Date of Death 19
Age 62 Years Months Days Birthplace New York
Cause of Death Bronchopneumonia lower lobes of both lungs
Certificate was signed by I wr.enQe...P* Corbett M.D.
Address VA Hospital, 113 Holland Avenue, Albany, New York
Place of Burial (or Removal Queensbury New York
(If body is to be temporarily held, ill in space later)
Cemetery Seeley Date of Burial 8-5-75 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 136 Warren Street
to Potter...Funera1...Servie Glens...FaLLs,...NY
(Name) (Address)
the Unciqrtak..ex to hold temporarily and inter the body
(Undertaker or Benoit���� awing charge of corpse) ( ;'r,I move({ otherw se dispose of (state how))
Dated tt55�� 19 (Signed) �[..t....�, ?`. e' '�
ocal Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a .ody 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. (R1 V. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of )1GL4:17)1 was 19 73
(Interment or Cremation)
/3") ,
(Name df Cemetery, Gceataterrvm;-cte.)-
Section Lot No. Grave No.
(Sired) / ��T 1 (. /477---/z4,-
(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.