Adams, Robert NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fa' 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, Villa Registered No.
Dist. No. 4601 County Schenectady or City -5cht r
(If city give street address)
Robert G. Adams Yes WWI
Name of deceased Veteran
(If veteran, give name of War)
Male Single, married, widowed, Marries' Sept. 21, 19761
Sex or divorced (write the word) Date of Death ICY 19
Age 76 Years .Months Days Birthplace
Cause of Death Terminal Pneumonia
Certificate was signed bye* l Woodruff
M.D.
Address 1003Union St., Schl dy,
Place of Burial (or Removal) Glens Falls, NY
(If body is to be temporarily held, fill in space later) 2,�{�976
emeter Pane View Lein. Date of Buria2SePt• 19
;If body isto he 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-
Lion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to Baxter Funeral Home 40 N. Brandywine Ave., Schenectady, NY
Under der (tri4o6)
the .. to hold temporarily
he body
(Und retapl{e:Q 'ers'oving charge ofcorpse) Inter, r other dis of (state w )
Dated GG (Signed) ..' �... . e.
Local egistrar
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) (9A2-205) 9t
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of J��2 a • 2 9 7'
(Interment or Crew=___a.,1_„_.,
1i, �_ ..
(Name of Cemetery, C ,
0-3d(w-;
Section Lot No. 7 Grave No. 7/
(Sign 6j
(Person in Charge)
Address e46 / l�
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.