Bazinet, Elizabeth 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 CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. l l//`
Registered No.
5601 Warren Town, Village Cityof Glens Falls
Dist. No. County or City
If city, give street address)
Name of deceased Elizabeth M. Bazinet Veteran No
(If veteran,give name of War)
Female Single, married,widowed, Widowed March 6
Sex or divorced (write the word) Date of Death 19.1
Age 80 Years Months Days Birthplace New York State
Cause of Death Respiratory Arrest
Certificate was signed by John ulova M.D.
40
Address 7 Glens St. ,Glens Falls
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to be temporarily held, fill in space later)
Cemetery St. Aiphonsus Cemetery Date of Burial March 9 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 registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE-
BY GRANT A PERMIT
to Regan & Denny,Inc. Quaker Rd. 1Glens Falls, N.Y.
(Name) (Address)
the Undertaker to hold temporarily and Inter the body
(Unlertake o e= rge of corpse) (Inter, remove, or oh�e ise s tate w))
Dated 19_��' (Signed) '
Local Registrar
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) (6A2-130)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
��� 1 �7C
Date of ��� �rt7 Y was z�' / 19 / �
(Interment or Cremation)
( ame of Cemetery, Crematorium, etc.)
Section J1 Lot No. '� Grave No. /
T � `
(Signed)
(Pbrson in Charge)
Address 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
UNDERTAKER 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 UND'-
TAKERS violating the law relative to the return of p s
are liable to a penalty of NOT LESS THAN FIVE 1 -
LARS NOR MORE THAN FIFTY DOLLARS FOR ./.
FIRST OFFENSE. The law will be enforced. Local Re:
trars are required, under penalty, to report violations there f.