LaMoy, Hugh NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT `..A7.-
tar 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.
Dist. No. 1701 County Fulton or City Gloversville
(If city, give street address)
Name of deceased Hugh...W......LaMoy Veteran
(If veteran, give name of War)
Single, married, widowed,Sex male or divorced (write the word)married Date of Death Fe.b......2.8 19 6.9
Age 61 Years Months Days Birthrlace New York
Cause of Death Acute myocardial infarction
Certificate was signed by Edward S. Holcomb M.D.
Address Gloversville, N. Y.
Place of Burial (or Removal) Glans Falls, N. Y.
(If body is to he temporarily he d, fill in space lat )
Cemetery bt. Alphonsus Cem. Date of Burial March 4. 19 69
(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 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
to Hollenbeck Funeral Home, Inc. Gloversville, N. Y.
(Name) (Address)
the undertaker to hold temporarily an, 'liter the body
(Undertaker or person havinp�.charge of corpse) ' n r emove, or other se dispose+of state,h• )�
Dated Marck1.... .,.1.9 9 19 (Signed) . ' '
Local Registrar /
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the State (subject to loca/cemeteryor
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
Date of 1 1A.Gr—Yt/YY1.P Jwas Cep A ( 1( 19
(Interment or Crematior„La-
(Name of Cem tery, Crematorium, etc.) /
Section 7 (?Ota) )< Lot No. j l f 0(O Grave No. 3
_ r
(Signed)
(Person in harge)
6
P
Address L'Cc )
Person in charge must return this Permit to the Registrar
of his District within SEVEN (1) 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.