Wyman, Rex Form VS sL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fa 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 Registered No.__...
1
V26 Wash. or City Hudson Falls,
Dist. No. �...........County City
(If city, give street address)
Name of deceased Rex W. vlyman Veteran no
White Single, married, widowed, Married (If veteran name of 19>May 25, 62
Sex Male Color or divorced (wnte the word) Date of Death
Age 49 Years Mons Days Birthplace Byron, Mixln,a
Cause of Death (`runshot wound - head - extyensive
Certificate was signed by Robert W, Homer, Coroner's Physician M.D.
Address .Hudsmn..F.alls.r..1i...Y...
Place of Burial (or Removal) Town„9j.. ieepsbury,, N.Y,
(If body I.to be temporarily held,All in space later)
Cemetery Pine View Cem� , Date of Burial May 28, 19.62 19
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
:o Regan & Denny, Inc. Glens Falls., N. Y,
(Name) (Address)
the under.take.r..,....Chas.•.Ii...Denn ...•.•....to hold tem•o . 'ly mnd ' tar the body.
(Undertaker or pen having charge of corpse) . er,remo , otsty�t wls�disnose state howl)
Dated May 28, 19 b2 (Signed)
toe Registrar
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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTFINENTS OR CREMATIONS
ARE MADE
Date of
(Interment o
( ne of Cemetery, C7torian, a)
Se ion Lot No. - Grave No.
(Signed)
.. (Person In charge)
r'
AddreSS �{ A?
e2t
Person in charge must 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 UNDERTAKER MUST SIGN ABOVE STATE-
MENT, 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 re-
quired, under penalty, to report violations thereof.