Sanders, George NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Qr 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 • 0 COMPLETE CERTIFICATE OF
DEATH, LEGIBLY/ WRITTEN IN DURABLE BLACK INK. i
,� (� ( nty� "�1;�` j� Registe d No.
Dist. No. ... 9 •o�vrt�r t
f c• y give street a ress)
Name of deceased 1.... r..-j = -ra
Ir (If veteran, give name of War)
ry........orf2.1-,
Single, arried, wido, .,
Sex \1/4 . or divorced (write )- - word) Date of Death ' 19 ••..
Age Years I • M+nth. . -%^ Birthplace
Cause of Deathlik f:: ... .., -.-' (�
Certificate was signed Ai' ON�ILt► IN. !:).. M.D.
Address .- . .. .. .... - .;; IV- r`
Place of Burial (or 'emov. )
(If body is to be temporarily h.Id, f` 1 in spa 0
Cemetery / Date of Burial 19
(If body is to be temporarily he d, ill i, s•:ce later)
The CERTIFICATE ►F DEA H con .i • g the above stated particulars, having been presented to me, after careful examination, the
same appearing to be COMP a. _ORR CT AND SATISFACTORY AS REQUIRED BY LAW, have accepted the same for registra-
tion, have rec. --d it • m .V. Reco� wik the above stated Registered N mber and on/ibis thereof I H REBY GRANT A
PEc • ii ��_to lylir �`C��' • .. % ...9160
dd
the .. . r� ���!� to hold temporari d s the body
(Under s
•r person aving charge of ote) (Inter, re • et erwise dispose •f (vac how))
Dated .... /
1 `�t` (Signed)
ocal Registrar
This Perm' is suffi lent for the Removal (and Interment or Cremation)of a body to any part of the State (subject to local cemetery or
other regulat'•ns), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
FORM VS• 61. IREV. 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
/,
Date o ti ft ' was ''`'-V /05 19 49
(Interment or,- xqn)
/4 / 4
_ �Ei
(Name of Cemetery,
Section Lot No. Grave No.
(Signed) a Al--A1, —.,
(Person in Charge)
Address ' '
Czz-ev'
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.
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
[r 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. ..1 I -.__.
Dist. No. t. Q I County._\a or City - F�--�e-e_./ 4-ress)
(If city, give street address)
Name of deceased . ... .. ,,t._.- \\ - Veteran
(If veteran, give name of War)
Single, marred, widowed, •-
Sex Av. e Y . or divorced (write the word) Date of Death ..a — — 19 ..LFI.
Age.... . - Years Mo the Da-}1,;—%"±-
Birthplace 1.y,. Lf(
Cause of Death Al.., Z.
Certificate was signed by Virt,:..,,,,:)N. N._ R 1 M.D.
Address . .`"1...... K ia..aC- -$r?, .. 3(3--....... . .a Q.-et"2,......J
Place of Burial (or Removal) .•-•s,._
(If body is to be temporaril• held, fill ins ace later
Cemetery .. 0 Date of Burial '3—k., - 19 I•
........ . .. .
(If body is to be temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, ha g been presented to me, after careful examination, the
same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS RE IRED 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
PERMITto
(Name) 1 `�"'(Address)
the 1 .., to hold temporarily and . • body
p y �.., the
(Undertaker or person having charge of corpse) ('(Inter, remove, or of •dispose of (state how))
Dated a. — L. — 19 ..b (Signed) Q,.,, ..lG.L,e,-e, ....
Loca egistr
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the State subjec 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. 6/631 13A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of ''was 19
(Interment os..Cremation)
(Name of Cemetery, Criam,—"etc.)
Section 2,4 "44� Lot No. Grave No.
e/d4-
(Signed) 2";f2
(Person in Charge)
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.
Pnrm VS Al.
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER ' S REQUEST TO DISINTER BODY
1 See Special Administrative Regulation I, subdivision 4, Relating to the Trans-
portation of Dead bodies by Common Carriers, as printed on the back of TRANSIT
LABEL.
N. B. Permission for disinterment must ALWAYS be obtained whether the Body
disinterred is to be transported by Common Carrier or by other means.
I HEREBY REQUEST PERMISSION TO DISINTER the dead body of
George N. Sanders , who died in the* City
(City. Village, Town)
of Glens Falls on* March 4., 1969 , Sex Male ,
Color or race* White , Age* 62 years, and Cause of Death*.NyocarUi.?J.
_Infarct.J,on. NOW INTERRED IN Pineview Cem.
(a) The body is to be TRANSPORTED BY COMMON CARRIER for
at
(State fully the disposition to be made of body) (Name of place or cemetery)
(b) The body is NOT to be transported by Common Carrier but is to be Intexred_
at e.st...G1.ens...Fa.J,1.s..C.e le.tery
(State fully the disposition to be made of ) - / (Name place or cemetery)
r
(Signature of undertaker) , a ...�7`<:...
Dated April 17 19... ... Address..3 4..Ba.y...FLd....Gl.ez�s...Fs].]s.,...N..Y.
License No. 003 802
APPROVAL OF HEALTH OFFICER
Dist. No.
I HEREBY APPROVE above Request and recommend that Permission be granted.
7c2(Signature of Health Officer) ) �>
Dated 19.4.Y..
(. "Instructions to Local Registrar: Fill out (a) Transit Permit for bodies trans-
ported by Common Carrier or (b) ordinary Offical Burial (or Removal) Permit for bodies
not to be so transported, in each case writing the word"DISINTERMENT"on the Permit.
The data required concerning the decedent may be filled in from the local register or
cemetery record. When data can not be obtained write "Unknown" in spaces in-
dicated by (*).
The Disinterment blank should be filed and carefully preserved in your office.