LaMora, John NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
iSr 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. 2
Registered No.
Town, Village
Dist. No. 198 County Albany or City Albany_,__.New._.York
If ciww give street address)
II
Name of deceased John S. LaMora Veteran
(If veteran, give name of War)
Sex Male Single, married,widowed,
or divorced (write the word) Divorced Date of Death 1/2/19 79
Age 59 Years Months Days Birthplace
Cause of Death Cardiac arrest, assumed
Certificate was signed by G. Tinker M.D.
Address VAMC 113 Holland Avenue,Albany, New York
Place of Burial (or Removal) Queensbury, New York
(If body is to b�tgmporryly aId, fill ill in space later) 1/5 9
Cemetery OM• HH1l II1l Date of Burial 1�
(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 Potter Funeral Home 136 Warren St. ,Glens Falls, New York
(Name) (Address)
the Undertaker to hold temporarily and If. er' the body
(Unlertaker or person having clan of corpse Int r, emove, r other, ise dispose of (state how))
Dated 1/G 19 (Signed) ....=------ -x o--.4z.g
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremati ) of a y to any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in which case Transit Permit (VS No. 62) is required.
FORM VS.61.(REV.6/63)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of Interment was 4-2i 19 79
(Interment or.Cremation)
St. Alphonsus Cemetery
(Name of Cemetery, Crematorium, etc.)
Section I Lot No. R-2 Grave No. 7
(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.