Hafner, Hubert NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
far 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, Village Registered No.
5601 warren g dens Falls •
Dist. No. County or City
(If city, give street address)
Name of deceased Hubert Hafner Veteran No
(If veteran, give name of War)
Male Single, married, widowed, Marriod 3/18/76
Sex or divorced (write the word) Date of Death 19
Age 43 Years _ Months, Da s Birthplace NY
•
Cause of Death Q9A.,,
Certificate was signed by M.D.
Address 325 Main St. , Hudson Falls, NY
Place of Burial (or Removal Removal Town of Oueensbury, NV
(If body is to, Ine8mpvewlyChemeteryspace later) 3 22 76
Cemetery ��''�1 V1 Date of Burial / / 19
(If body as 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
rarleton Funeral Home, Inc. , Main St. , Hudson Falls, NY
to
(Name) (Address)
C. Bruce Wet Wore Body place in receiving vau
the to hold temporarily d y �le body
(Undertaker or persop having charge o corpse) ter, or pose of (state how))
Dated ,- 19 /L. (Signed) reins, rw,....
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a bod 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. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
• OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date ofy e 44'>'T was )1(. 14;K7'19 7
(Interment or Cremation)
(Name of Cemetery. Cremarnriur.l
abo-iyAi/72t--
Section Lot No. Grave No.
(Signed) e
(Person..in arge)
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.
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 12Kale Age(yrs.)
Hubert Hafner 0 Female 48
Place of Death (indicate whether city, village or town) Date of Death Cause of Ueath
Glens Falls Hospital 3/18/76 Ventricular Fibrulation
Cemetery now interred Location (city,town or county) Is body to be transported by common carrier?
Pineview Cemetery Town of 0ueensbury, NY 0 Yes (No
State fully the final disposition to be made of body.
To be intered in the ground.
Name of place or cemetery for final disposition Date of final disposition
Kingsbury Cemetery, Town of Kingsbury, NY 4/28/76
Firm Name Reg. No. Address
Carleton Funeral Home, Tnc. 00356 68 Main St. , Hudson Falls , NY 12839
;Signature of Funeral Director or Undertaker -, Reg. No. Date
C. Ilruce Wetmore C 3Lafc& � Ifs 2+�U 05978 4/23/76
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.
',dies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit.