Stoner, Albert • Y•"•• • •`N •.c•1/ I VI1% VIQIG L/VV.:II II II III VI VI GO,III
BURIAL — TRANSIT PERMIT
Name: First Middle Last Sex
Albert Stoner Male
Date of Death 980 Age 84 If Veteran of U.S.Armed Forces,War or Dates
Sept.25, 1
Place of Death: Town orf Villte Hospital, Institution or Street Address
w �` ty oens Falls Glens Falls Hospital
w Causes of Death: Trauma, fracture T7 Vertebra, lacerations lung,subarachnoid Hem.
w Medical Certifier:Name Title Address
A S. Richard Spitzer, MD, 90 South St. ,Glens Falls, N.Y.
Death Certificate Filed:City,Town or Village District No. Register No.
City of Glens Falls, NY 5601
Burial:
Date Cemetary or Crematory Address
❑ Cremation: Sept. 29, 1980 Pine View Cemetery Tn of Queensbury,NY
Removal Date Place Removed and/or Held Add�ss.
O ❑ and/or Hold:
E-
'Y1 Date Point of Shipment Destination
Q Transportation by
Cto ,—, Common Carrier:
4
A Date Cemetary Address
Disinterment:
Reinterment:
Permit Issued To:Name of Funeral Firm ess
Regan & Denny,Inc. Quaker Rd. ,A ens Falls, NY 6. ion No.
Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other Than Above:
E- Address:
Permission is her jay ,a��ted t, dispose of the dead human remains described above as indicated o
a Date Issued �'Qo� �7 1 9�o Re i trartal Statistics i not,,,----
le,))
District No.
360 / 9 9
Place
his permit must be completed on back by the person in charge at the place of dispo • n d with the registrar of vitalstratistif
city,town or village
where disposition took place.
1191
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PUBLIC HEALTH LAW
§4145. Deaths; burial and removal permits; disposition of remains.
1.No person in charge of any premises on which interments,cremations or other disposition of the body of a deceased persc
shall inter or permit the interment or other disposition of any body unless it is accompanied by a burial,cremation or transit permit,as provided
- in this article.
2.The funeral director or undertaker shall deliver the burial permit to the person in charge of the place of burial or other disposition,before
interring,or otherwise disposing of the body;or shall attach the removal or transit permit to the box containing the body,when shipped by any
transportation company,which permit shall accompany the remains to its destination,where if within this state,it shall be delivered to the
person in charge of the place of burial or other disposition.
3.The person in charge of the place of burial or other disposition shall endorse upon the permit,the date of interment,or cremation or other
disposition over his signature, and shall return all permits so endorsed to the registrar of his district within seven days after the date of
interment, cremation or other disposition.
4.When burying or otherwise disposing of the body of a deceased person in a cemetery or burial place having no person in charge,the
funeral director or undertaker shall(a)sign the burial or removal permit,giving the date of burial;(b)write across the face of the permit the
words"No person in charge:"and(c)file the burial or removal permit within three days with the registrar of the district in which the cemetery is
located.
5.The person in charge of the place of burial,cremation,or other disposition shall keep a record of all bodies interred or otherwise disposed
of on the premises under his charge,in each case stating the name of each deceased person,place of death,date of burial or disposal,and
name and address of the funeral director or undertaker, which record shall at all times be open to official inspection.
ENDORSEMENT OF SECTON OR PERSON IN CHARGE OF PREMISES. �f
I certify that the remains were disposed of in accordance with the permit on the reverse side on 9/`'/�1C? .)
(Date)
a P.
at
(Plac of disposition and address)
Section 1/471P4.tgei.A-e,.1 Lot No. Grave No.
Signature c.\- ' 44*,34,
122�' Title
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