Yunich, Max NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
- 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. 7 3
Dist. No. 4102 County Renss . or City Troy, N.Y.
(If city, give street address)
Name of deceased Max Yunich • Veteran
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) Married Date of Death Jan. 19 19..64
Age ti 0 Years Months Days Birthplace Russia
Cause of Death Cer-ab.r-a_l_..vasd-u_lar_..thr-o;ubos s
Certificate was signed by DP-:---Irving--,St-rosberg M.D.
Address 3-8 - 1st- St. , Troy, N-:-Y.
Place of Burial (or Removal)
(If body is to be temporarily held, fill in space later) (�-TleYl Fa�1.�i) 'Y
Cemetery -Shasta f 11a-__-Cer-, Date of Burial Jan�__.2I2.--. 19___6b
(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
to Thomas Minahan 67 Park St. , Glen Falls, N.Y.
(Name) (Address)
the Undertaker to hold temporarily and___Inter the body.
(Undertaker or person having charge of cos se) (Inter, remove, or.�the se dispose rotate
yirla
Dated Jan. ...2.0 19,66 (Signed) A, �`--C..-- ,��/ 6(,/,�• ' e,W,047
Local 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.
Form VS. 61. (Rev. 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
11 1 '
Date of t\k'LN— ,or was \,' .r,� . ) -) 19 C
(Interment or Cremation
(Name oP Cemetery, Cremat)rium, etc.
2 1i
Section Trot No Grave No.
�/'
(Signed) LfL-z y'.t
(Person in arge)
ti _
Address \\ri '`1��, \A V �^
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) JAYS 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.