Steves, Richard 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, Villa Registered No.
101 Albany glbany
Dist. No.. County or City
Richard Steves (If city, give street qidress)
O
Name of deceased Veteran
(If veteran, give name of War)
Male Single, married, widowed, Single Jan 8 69
Sex or divorced (wr the word) Date of 3t 19
7 ecrlrState
Age YeariTeart t'a141.1411,b. Days Birthplace
Cause of-Death
M-• ?ran-1u
Certificate was signed by. M.D,
Address „ klbany Medical Center Hospital
Place of Burial (or Removal) TOWn of Queenetui''J NY
(If body is to be to }iiiti h g llre(`caeoIn fe T'
Cemetery r l j�G y Date of Burial Jan 11 19 69
(If body is to be temporarily held, fill to 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&nlienn basis
y thereof I HEREBY GRANT A PERK .1l Glen St . So . Glens Falls NY
to
lindertaker(Name) inter (Address)
the to hold temporarily and the body
(Undlildefittmn lArng charge of cor (Inter,remove,gr otherwise dispose,of [5ta to how]),-,--,---
Dated Dated 19 (Signed) 1-,:;..j.cs- ._A , " , .1. .a.4,.<
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subj t 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. (Rea, 6/63) (3A2.323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS O,R
CREMATIONS ARE Lnajjwa-sMADE
Date of -�f,.� I / 19_ Z;:f(Interment
(Name of Cemetery,Cam)
Section / Lot No. Grave No.___._.____
(Signed)
(Person in Charge)
Address _ ( 14"'
>.
Pelson in charge must return this Permit to the egistrar
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.