LaPointe, Patricia NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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.
3
Town,
Registered No.
NIX1c1WE
Dist. No. 5651 County Warren xxxxtsx Lake...George
(If city, give street address)
Name of deceased P.atri.cia. Rob.ins.on. LaPointe Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the word) Married Date of Death 9/9 19 18
Age 23 Years Months Days Birthplace New York State
Cause of Death Multiple Trauma, Major Head Injury
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 he id fill in space later)
Cemetery St. A phonsus Cemetery Date of Burial 9/12 19 78
(If body is to be 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
to Sullivan & Minahan, Inc., 6.7 .Park .St...7.,Glen,q.,galls,...N.Y....12801
unde(Plenr inter tiaaress)
the to hold temporarily and the body
(Undertaker or ersonp having charge of corpse) (Inter, re ove or oth i e cirri e o (state how))
Dated sept. 11 19 78 (Signed)
Lo 1 gis ar -
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part o he 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 Inter1l nt 9/12 19 78
(Interment or Cremation)
St_ Alphonsu s Cemetery
(Name of Cemetery, Crematorium, etc.)
Section Sp- C Lot No. 2 Grave No. 2
(Signed) l �L t r
(Person in Charge)
Address 35 Broad St. , , Glens Fails, i .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.