Chenier, Arthur NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Z 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 CER-
TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village
Registered No. in
Dist. No. 198 County Albany or City 113 Holland Avenue, Albany, New York
(If city, give street address)
Name of deceased Arthur T. Chenier WW Veteran II
(If veteran, give name of War)
Male Single, married, widowed, Married 3/22 65
Sex or divorced (write the word) Date of Death 19
Age 53 Years Months Days Birthplace New York
Cause of-Death Cardiac Arrest
Certificate was signed by John Jarmolych
M.D.
Address
VA Hospital, Albany, New York
Place of Burial (or Removal)..., West Glens Falls, New York
(If body is to be temporer'y he t ace Iater)
Cemetery b�l�'h8x�gus Date of Burial 3/25 19
(If body is to be temporarily held, till 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
to Sullivan and Minahan, Inc. 67 Park Street,Glens Falls, New York
the UndertakerName) Int (Address)
to hold temporarily and the body
(Undertaker or person having charge of corpse) (Inter, rq�to,e isp, o otherwise ose of [state h
Dated 3122. 19.65.. (Signed) /__.. t._. .......
Local Registrar kh-11L.,
This Permit is sufficient for the Removal (and Interment or Crem Lion) 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. (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date of -N. E4ImrzC was / 9t-a- a S 19_.k .
(Interment or Cremation)
L
—�%��'1/ a of Cemetery. Crematorium, etc.)
•
Section .V Lot No. I Gruvvcc 4No.____
(Signed) ._
(Person in Charge)
Address — `I S -
,..."._ ,tle .
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 Dis-
trict 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.