Trackey, Lawrence 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. ,--7
Registered No. U
Town, Village
Dist. No. __-_ County -Warren or City City-__Q_ __-Glens___Fa1iR
If city, give street address)
Name of deceased Lawrence P. Trackey Veteran Yes — WW II
(If veteran, give name of War)
Male Single,married,widowed, Married
Sex or divorced (write the word) Date of Death Feb. 5 19 79
Age 5/4 Years Months Days Birthplace New York._,State
Cause of Death Metastatic Carcinoma
Certificate was signed by Robert A. Reid M.D.
Address 8 Harrison Ave.,Glens Fallss N.Y.
Place of Burial (or Removal) TQwn of Queenebury_a_.__N.N.Y.
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Cemetery Date of Burial Feb, 7 19..79-
(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. ,Glens Falls, N.Y.
(Name) (Address)
the Undertaker to hold temporarily alld ter the body
(Unlertak�or pe on having charge of corpse) z er, remo e, or thgrwise ispose of (state how))
Dated 19_��.-' (Signed) /i . s7 /`��
Local gistrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to an 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)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of ;-L4-111�itwas 19 / 7
(Interment or.ererirattani---.
_.mot a2 c 1 - -I e.-LC�
(Name of Cemetery, CeYNma+nrium etc.)___
((6
Section t`�`-elLot 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.