LaPointe, Randy NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
f 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, Registered No. 2
aiazgx
Dist. No. 5651 County Warren ct ) , ham.George
(If city, give street address)
Name of deceased Randy...James...LaPointe Veteran Na
(If veteran, give name of War)
Male Single, married, widowed, Married 9 9 78
Sex or divorced (write the word) Date of Death / 19
Age 21 Years Months Days Birthplace New York State
Cause of Death Multiple Head, Neck and Thorax Injury with Skull Fracture
Certificate was signed by S. Richard Spitzer M.D.
Address 90 South St.—Glens Falls, N.Y. 12801
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to he temporarily held, fill in space later)
Cemetery S.t.....Alphonsus...Cemetery Date of Burial 91.12 19.7.8
(If body is to 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•
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT Sullivan & Minahan,Inc. 67 Park St.-Glens Falls, N.Y. 12801
to
(Name) (Address)
the undertaker to hold temporarily and inter the body
(Undertaker or person having charge of cow se) (Inter, r: s ot-e, or - w e e of I.tate how))
Dated Sept 11 19 T8
(Signed) f.
a 'egistra
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part .� 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) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of Interment was 9/12 1928
(Interment or Cremation)
St_ Alphnnsus Cemetery
(Name of Cemetery, Crematorium, etc.)
Section Sp. C Lot No. 2 Grave No.
(Signed)
(Person in Charge)
Address 35 Rrnari St_ � fr1 ens Fa11 s,H_Y.
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.