Meyer, Marie 110 VI I,U V. II I J) INGIVII I VI I \,71.121.0 ✓Gtlal 111 IQI It WI I 1001111
BURIAL — TRANSIT PERMIT
/"Name: First Middle Last Sex
/ Marie Meyer Female
DatG f Death •16 1980 Age If Veteran of U.S.Armed Forces,War or Dates
—, ov. , No
Z PI f Death'Ci Town or la Ho tal, Ins t do or Street Address
A Ut ,y of lens Ia9ls, N.Y. Glens Falls osp a�
v Causes of Failure
A Mtotar.iefI Omer MD 100 John gee.
Hudson Falls, °illdr.ys.
Death Certificate Filed:City,Town or Village District No. Register No.
City of Glens Falls, N.Y.:::>
Ja Burial: 5601y
Date Cemetary or Crematory Address
❑ Cremation: November 20, 1980 Pineview Cemetery, Twn Queensbury, NY
Z Removal Date Place Removed and/or Held Address
. O ❑ and/or Hold:
rn Date Point of Shipment Destination
o Transportation by
a ❑ Common Carrier:
4
ADate Cemetary Address
Disinterment:
0
Reintermdent: aa1 ��qq PebarietOria`�unerai ifome Inc. Main Stddres F:gp. ration No.
1 , , . Hdson Falls, N.Y. 00}7b�
Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other Than Above:
E-. Address:
04 Permission is herebyArante to dispose of the dead human remains described ab•ye as in. ted
a Date Issued / / /7.G .4
-eg strar,• l tic Sig/ ure)
/
District No. >> 6 0:r .4 .��__ - f
Plac
his ermit must be com leted on back b the erson in char eat the lace of dis osition and filed with the registrar of vital stati ics of the city,town or village
P P Y P 9 P P 9
where disposition took place.
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 person are made
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 b rial 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.Whentburying 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.
I certify that the remains were disposed of in accordance with the permit gn,the reverse side on / /7avet/ed
�— (Date)
/,--itA7,0/-
at Z11-1—
(Place of isposition and address)
Section Lot No. 7 ,9 Grave No.
Signature s Title c3.t I