Cary, Albert L— NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
it 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.
1702 Fulton Town, Village Johnstown
Dist. No. County or City
If city, give street address)
Albert Haywood Cary
Name of deceased Veteran
(If veteran,give name of War)
Male Single, married,widowed, Widowed 1/6 80
Sex or divorced (write the word) Date of Death 19
Age S8 Years Months Days Birthplace New York
Cause of Death Acute myocardial infarction
Certificate was signed by Zae--.seol Sin., M.D.
Address Johnstown,. N.Y.
Place of Burial (or Removal) NVBXXXinikEECKENNVIMMIN Pine View Cemetery VAULT
(If body is to be temporarily held, fill in space later)
Cemetery Queensbury, N.Y. Date of Burial 1/10 i98O
(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 M.B.Kilmer Funeral Home Argyle, N.Y.
(Name) _ (Address)
the undertaker to hold temporarily an AL T the body
(Unlertaker or person having charge of corpse) n , emove, o h. wis pos (state how)) -
Dated 1/7 1980 (Signed) L
D p Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a bo 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. 6/631 18A2-78)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
/^ / /G ey
Date of `�'��)" was 19
(Interment or Cremation)
(Name of Cemetery, C +elorhrm;-etr)-
"// )
Section Lot No. ve No.
(Signed)
(Person in Charge)
Address
/ , ' ,de.
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.
s.
Form VS-67 (rev. 1I 051
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, band-print 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.
1 hereby request permission to disinter the dead body of:
Name of Deceased Male Age(yrs.)
Albert Heywood Cary 1..1 Female 8e (June 2,1891)
Place of Death (indicate -..hether city, village or torn) Date of Ceath Cause of Death
Johnstown, hew York Jan.6,1980 Acute myocardial infarction
Cemetery now interred Location(city,town or county) Is body to he transported by common carrier?
PineView Gem. Vault Queensbury, Lew York ❑ Yes la No
State fully the final disposition to be made of body.
Removed from vault and buried in family lot.
!.arm of place or cemetery for final disposition Date of final disposition
Adirondack Friends Cemetery — Queensbury, N.Y. May 17,19Rn
Firm, Name Reg. No. Address
M.B.Kilmer Funeral__Hone ___- 0-13.27 6401 Main Street Arg le, N.Y. 12809
'Signet a of Fun al Director or Undertaker Reg.. No. ate
02885 May 15,1980
INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER:
1. See Section 13.1 (formerly Chapter XIII, 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. -I he 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.