Ridings, Alice s., NEW YORK STATE DEPARTMENT OF HEALTH
4_ 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,
Vilfage, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CE TIFICATE OF
DEATH, LEGIBLY WRITTEN IN DU ABLE BLACK INK.
Dist. No....S‘ef _Lty•
A.....), ,,,
Single, married, widowed, (If city, give street adlress •-....----"'
veteran, give name of War)
oTrozwnit,yVillag Re • e d No 3
Name o d-cease ... ... Veteran veteran,
C . 4I2C
Sex /0 or divorced (write the word)',/y.Ctilz7.4..12-1 Date of Deat.3 — ... . ....19 .26.
A 1 Year Months • ysove2 Birthplace
Cause of D7ath C1-1?. ),1Z):re--ael-,ec.,4••'?-1-d.
Certificate was si ed by . . M.D.
Address
/1....tY.
Place of Burg r Removal )...‘.
(If body is to . • porarily h d fill i spac ,Tt_c_tfec
Cemetery . Date of Burial 1 -r7,/- ?' 15-2
(If body as to be temporarily he ddliPIM-Ipace later)
The CERTIFICATE OF DEATH containing the above stated particulars, Navin: been presented to me, after careful examination, the
same Appearing to be COMPLETE, CORRECT, AN SATISFACTORY AS REI! 1 'ED BY LAW, I have accepted the same for registra-
tion, ve recorded it in 1 Local Record with th above stated Register I mber, and on the basis thereof I HEREBY GRANT A
PE 7IT _ ..0.0;82-7
to c,..— st ---- Acid le±....9
,.....4 ,-- -7.--i-I
the to hold temporarily and
/ the body
(Underta er or person having charge of coose) (Inter, remove, or otherwise dispose 61-(state how))
Dated /— .2- ? 19.4 (Signed)
Yita 77LocrAsgiavg. ' tr.
This Permit is sufficient for the Removal (and Interment or Cremation)of a body ilny part of
the State (11116ject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Perit (VS No. 62) is required.
FORM VS. 61. (REV. 6/63) (A2-248)
A
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
•y CREMATIONS ARE MADE
Date of �- �ii�2e�-��was %� 19J�
(Interment or )
i=c?
(Name of Cemetery,-Gretrarteri m,.tt�. _\
Section J� 'i Lot'No. Grave No.
(Signe (-`
(Person in Charge)
Address �` /" "r
—/ d"" /C- t
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. 11165)
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.
1 hereby request permission to disinter the dead body of: .
Name of Deceased Male Age(yrs.)
Alice M. Ridings Female 49
Place of Death (indicate •whether city, village or town) Date of Death Cause of Death
Glens Falls, N.Y. (City) 1/26/76 Heart failure
Cemetery now interred Location (city,town or county) - Is hody to be transported by common carrier?
Pine View Rec. Vault Tn of Queensbury,NY O Yes la No
State fully the final disposition to be made of body.
• Internment
tame of place or cemetery for final disposition Date of final'disposition
South:ice Cemetery,Tn of Moreau, NY 5/8/76
Firm Name Reg. No. Address
Regan ?; Denny, Inc. 02683 quaker Rd. ,Glens Fs1 ls, NY
:slgnatura o run al Direct or rtrtker Reg. No. Date
0 794 5/6/76
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.