Stafford, Martha NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
eir 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. ii.
County 1 1 AlbanyTown, Village Bethlehem
Dist. No. �? y or City
If city, give street address)
Name of deceased Martha C. Stafford Veteran No
(If veteran,give name of War)
Single,married,widowed,
Sex Female or divorced (write the word) Divorced
Date of Death June 12, 1980
Age 52 Years Months Days Birthplace New York State
Cause of Death __Sub_ara_ChfQid Hemorrhage
Certificate was signed by A. C. Lomotan, MD, Pathologist Office of Corners, M.D.
Address Albany County., Albany, N.Y.
Place of Burial (or Removal) _Que_e_nsbury_, New York
(If body is to be temp a,�ily held, fill in space later)
PineQView C ater)
'C Cemetery Date of Burial June 16, i9, $0
(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 Applebee Funeral Home, Inc. 1+03 Kenwood Avenue, Delmar, N.Y.
(Name) (Address)
the Undertaker to hold temporarily and Inter the body
(Unlertaker or person having charge of corpse) ter, re ve, or therw' a ispose of (state how))
Dated June-_.1_3_, 1980__ (Signed)
p Local Reg' ar
This Permit is sufficient for the Removal (and Interment or Cremation) of odyto any pa 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 ' '`-'s` was "'! /4 19 v
(Interment or Cremation)
(Name of Cemetery, ertmrcreivri
— c.)
Section / Lot No. '15 A6Grave No. J
(Signed) &���
(Person in Charge)
/� 1�.✓ 7
Address � Ale "` e•--"(
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.