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Webster, William 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. / 6 , Registered No. - ,�"�C)1 Warren Town, Village Cityof Glens Falls Dist. No. City If city, give street address) Name of deceased William D. Webster Veteran Yes, Korean,1.954-55 (If veteran, give name of War) Single, married,widowed, Sex Male or divorced (write the word) _Divorc.e_d Date of Death _.Dec_.___ 4 1977._ Age __.i4.5 Years Months Days Birthplace New York State Cause of Death Cardiopulmonary arrest Certificate was signed by Erich H. Loewy M.D. Address 62 Elm St. ,Glens Falls, N.Y. Place of Burial (or Removal) Town of Queensbury, N.Y. (I body i to be ti inearil ,lRec eiviri Vault Jan. Cemetery Viewg Date of Burial 3 1978 (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 Road,Glens Falls, N.Y. (Name) (Address) the Undertaker to hold temporarily and remove the body (Unlertaker or p s having charge of corpse ( rem , or t erwis• dispose of (state how)) Dated 1 c n 197k. n(Signed) , . al 'egistrar This Permit . sufficient for the Removal (and Interment or Cremation) of a body to any :art 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 Date of ��-"n-t. �-'-was //• 19_ (Interment or Cremation) (Name of Cemetery, Crematorium. etc) Sle Section v� Lot t No. Gra� PJo. (Signed) —�� / %����c ►� (Person in Charge) Address 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 UNDER- TAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOL- LARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Regis- trars are required, under penalty, to report violations thereof. te .11r VW •W.If•1 .i.w.G YG• wn•.V.G•.• yr ■1GAGI f1 OFFICIAL BURIAL (OR REMOVAL) PERMIT iii This permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration DIca,reti (Town, Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CE FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. Warren Town, Village Town o f Queensbury, N.Y. Dist. No. County or City If y, give street address) Name of deceased William D. Webst Veteran Les (If veteran,give name of War) Male Single, married, id owed, Dec. 30 77 Sex or divorced (w to the word) Date of Death19 Age 4, Years Mo1h -I Days Birthplace Cause of Death .% Certificate was signed by ) M.D. Address _ Place of Burial (or Removal) Tn Queensbury, N.Y. (If body is to be temporarily held, fill in s e ter) Cemetery Seelye Cemet y Date of Burial April 18 19 78 (If body is to be temporarily held, fil in-S\pace ater) The CERTIFICATE OF DEAT contai ng the above stated particulars, having been presented to me, after careful examination, the same appearing to be C PLET , CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registration, have recorded it in m 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. ,Glens Falls, N.Y. (Name) (Address) the Undertaker to hold temporarily and Inter the body (Unlertaker or,Gerson having charge of corpse) (Inter, remo otherwise dis ose state how)) Dated Y-/7 — 19-7 ' (Signed) _ _ _ ___4_�_ Local Regist r 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) (4A2-179) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE { - &frftlir 77 Date of was 19 (Interment or Cremation) (Name of Cemetery, C Section Lot No. Grave No. (Signed) (Person in Charge) } Address 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 UNDER- TAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOL- LARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Regis- trars are required, under penalty, to report violations thereof. jilf Form V3-67 (rev. 11/65) NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY In completing this form, please typewrite, handprint or write legibly all entries in permanent black or blue black ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN" in applicable spaces. I hereby request permission to disinter the dead body of: Name of Deceased Male Age(yrs.) William D. Webster Female 4 Place of Death (indicate whether city, village or to.vn) Date of Death Cause of Death City of Glens Falls, N.Y. 12/30/77 Cardio-pulmonary arrest Cemetery now interred Location (city,town or county) Is hody to be transported by common carrier) Pine View Rec. Vault Tn of Queensbury,N.Y. ❑ Yes jgt No State fully the final disposition to be made of body. Interment Nettie of place or cemetery for final disposition Date of final disposition Seelye Cemetery,Town of Queensbury, N.Y. 4/18/78 Firm Name Reg. No. Address Regan & Denny,I c. 02883 Quaker Rd. ,Glens Falls, N.Y. Signature of Funeral Airector r ndertaker Reg. No. Date 04794 4/17/78 o w INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER: 1. See Section 13.1 (formerly Chapter XII1, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies by common carriers, as printed on the back of the Transit Label. 2. The data required concerning the decedent may be obtained from the local register or cemetery record. INSTRUCTIONS TO LOCAL REGISTRAR: 1. For bodies to be transported by common carrier, fill out Transit Permit. 2. For bodies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit. 3. In each case write the word "DISINTERMENT" on the Permit. 4. This form should be filed and carefully preserved in your office.