Bardin, Baby Girl NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Igi 7.- 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 Re eyed No.
Dist. No. / '/ County .-- . . ,e---d------- or City , dee- --- ...-''
(If city, give street address)
Name of deceased -0 Veteran
(If v teran, give name of War)
Single, married, widowed, �,r
Sex . ............ or divorced (write the word) ... : .... .e- Date of Death /! 19lr
Age. Years Month Day� i� Birthplace
Cause of Death vc ���%
Certificate was signed by M.D.�� ....
Address � ,4,., e--,-,-- .
Place of Burial (or Removal 6X
(If body is to be temporarily h d, fi -in pace 1 er)
Cemetery L Date of Burial 19
(If body is to be temporarily held, fi in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same appe•• • to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have •rded it in my Los al Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMITto T%/
e. (Na en�) .... .. (Address)�'� ‘�
the ,/—, e..-c-- to hold temporarily and the body
(Underta er or person naving charge of corpse) (Inter, r ve, or of erwts ispose of (state how))
Dated . ..../. 19 .d (Signed) err ki... . ..
Local gistrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the tate (subje 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) (3A2-3231
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of , ' f was - ! / 19
(Interment otGtia
(Name of Cemetery, C , .)
j, �..............
Section { ` { ` Lot No. Grave No.
jr 17 127
(Signed) �� 4
(Person in Charge)
Address c� l cyL
"04,,0
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.
,URK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q 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, Vi Registered No.
Dist. No. -.') eo S 7 County :os-Gity,..
//1 (If city, gi• street address)
Name of deceased .... Veteran
(If eceran, give name of War)
Single, married, widowed, /
Sex or divorced (write the word) Date of Death .. c... - /Ce.L_ ✓ 19 6...7...
Age .Months Day Birthplace...,
Cause of Death /�
Certificate was signed by.....? .�........ .�: • ��� M.D.
..........
2.7 r
Address /,r �, — »•fir
Rom'
Place of Burial (or Removal) . r . , y/ _ - 4-t-41/
(If body Cemetery is cob empor 'ly hie .lac ���� .
ry .. ... p"' r J Date of Burial ,1. 19
(If body is to be temporari held, fill in ce ater) -
The CERTIFICATE 0 DEATH containi • th- ahoy, aced particulars, having been presented to me, after ' reful examination, the
same Appearing to be COMPLETE, CORR, ""`T•, •NP .ATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, ha recorded it in m Lo.a Record :,..:. , - above stated Registered Number and on the basis t eareof I HE BY G ANT A
PERMIT / J /
J,• 3./. f ./ram •
the ! to hold temporarily and -! �� the b dy
(Undertakerpr perso having charge o c. se) (Inter, remove .the,• ise dispose of ( i.t ow))
Dated la. 1 (Signedr ..
L• al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to an iert of the State (subject to loca 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 OFCREMATIO SEXNSTONARE ORMADE PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
A Date off-4✓' was /7i 19 if
(Interment9' C'��
(Name of Cemetery
Section Lot Nff." ir
�` �tirave No.
(Signed)
(Person in Charge)
90,
Address
4
Person in charge must return this Permit to t e 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.
- Pram V3 67.
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER ' S REQUEST TO DIS I NTER BODY
.—See Special Administrative Regulation 1, 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
Baby..Girl..Aard.jn. , who died in the*. ...City... .. . .
(City, Village, Town)
of Glens Falls on* Jan, 16,...1.969.....,....., Sex....Feama.le,
Color or race* White , Age*Still Fsth nd Cause of Death*
NOW INTERRED IN..p ne.,. ew.............. ..
(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
at. See1ye...C.e .,...Twn.....o.f..Queensbux�.y. N.Y.
( a .position to be made of bey))fate (Name of place or cemetery)
/ .. __ .. __
(Signature of undertaker) .u4.... ., i. .•. V' 0.0,3 .( `—
Dated May 14, 1969 19, Address...3.14....Bay...A,d. Gie
License No 11l... 1 C(
APPROVAL OF HEALTH OFFICER
Dist. No. 56.57.....
I HEREBY APPROVE above Request and recommend that Permission be granted.
(Signature of Health Officer) , -1k
Dated - -,-/ /.3 19 6 y
tInstructions 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.
M