Barney, Harold NEW TURK 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.
Registered No.
Warren Town, Village War rensbueg
Dist. No. County or City
i
Harold Joseph Barney If cityyVe stra¢s1
a�idiess)
Name of deceased Veteran wtN
(If veteran, give name of War)
Male Single, married,widowed, Divorced 3/23/79
Sex or divorced (write the word) Date of Death 19
Age 77 Years Months Days Birthplace NY
Cause of Death Sudden Death Syndrome
Certificate was signed by John B. Cunningham Jr M.D.
Address 90 South St. , Glens Fa1.' s, NY
Place of Burial (or Removal) Town of Queensbury, NY
(If body is to be temporarily held, fill in space later) 3/26/79
Cemetery St. Alphonsus Cemetery Date of Burial 19
(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 Car' eton Funeral Home, Inc. , Main St. , Hudson Fal Ts, NY
(Name) Inter (Address)
the C. Brine Wetmore to hold temporarily and the body
(Unlertaker or pegr�son having charge of corpse) (Inter, r ove, or otherwise d pose of (state how))
Dated /72 iti GL ? r 19 ( (Signed) .0 i (,.. m
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a; ody to any part of a 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
Date of Tnt armanf: was 4-25— 1
(Interment or Cremation)
St. Alphonsus Cemetery
(Name of Cemetery, Crematorium, etc.)
Section I Lot No.F9—F1 0 Grave No-Of 4,5 16
(Signed)
(Perso in Charge
Address ✓� �G��'� c�
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.