Barrett, Morris NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. '7 -
CSTown, Village Registered No.
Dist. No. 5601 County Warren or City City of Glens k'al,l,$
(If city, give street address)
Name of deceased Morris E, Barrett Veteran NO
(If veteran, give name of War)
Single, married, widowed,
Sex Male or divorced (write the word) _Married Date of Death ..August 1.2. 19 .77
Age 60 Years Months Days Birthplace New York State
Cause of Death Subdural I}ematoma
Certificate was signed by John E, Cunningham,Jr, M.D.
Address 90 SQuth St, ,Glens Falls, N,Y,
Place of Burial (or Removal) Town of Queensbury,N.Y.
(If body is to he temporarily held, fill in space later)
Cemetery Pin.e....View....C.emetelry Date of Burial August 15 19.77
(If body is to be temporarily held, fill in space ater)
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 Regan...&...Denny..,.1.nC.. Quaker...Rd...,Glens..Fres a7„ls, N.Y.
(Name) (Adds)
the Und.e .t.aker to hold temporarily and Inter the body
(Undertak r Resson having charge of cgr_pse) (In r remove, or otherwise dispose of (state how))
Dated /c1 19 . ... (Signed)
0
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to y part of the State s bject 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) (9A2-206) '=TsT:`.81
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of '7?t s f ' / s 19 9,7
(Interment or GP-mason)--��
_../..\yam
(Name of Cemetery, Cremator-ianr;etc.)
SectionC, Lot No. �- Grave No.
(Signed) �' tr a� = --
(Person in Charge)
Address `� ec
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.
BARRETT,
Lot NO, 102
Address
RD#1, Burch Road, Glens 'Tails, N.Y. Section NO
Owner Mrs. Ruth Barrett Plot Oneida
Date 8/15/77
100 Superficial ft. @ $2.50 per sq. ft.
Location
rinnnded nn the Nnrth by: Vacant, East by Path, South by Path, West by Vacant
Corner Posts
- —
Remarks
Deed No. (and changes) 1/1.50
Payment Record Paid in full 8/15/77
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Form No. 01
Record of Interments
, 1WA
61 Ruth E . Barrett 3/3/00 m moo) LDS'
2 I MORRIS E. Barrett (8/15/77). 6
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1
BARRETT, Morris E.
Age: 60 (1,-
Cause: Subdural Hematoma
Lot Owner: Ruth Barrett
Lot # 102, Oneida Plot
Grave # 2
Case: Concrete
Died: 8/12/77
Interred 8/i5/77
Undertaker:
Regan & Denny