Kral, Dennis NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
agir 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.
Town, Villa
Dist. No. �CU( County_.✓?..) '1,\-.....� or City
- '�-�� If cis ive street Name of deceased.Q -v,��.j ..---4- -_ Veteran -._.
(If veteran, give name of War)
Single,married,widowed,
Sex 727170-1—e--- or divorced (write the word) Date of Dea `3 19 OP
Age ._._ _ Years nths Days Birthplace
Cause of Death
Certificate was sign by _- M.D.
Address .
Place of Buri. or Removal) 41' �,
(If body is to . .orarily he 1, fill in space h er
Cemetery. , -.e..„ x, Date of Burial c9,- 19.c'
(If body is to (e temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination,
the sam ppearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same
for regi r tion, have recorded it in my Local ecord with the above st ted Registered Number, and on the basis thereof I HERE-
BY GR PERMIT
to
(Na ) (•Address)
the _ _ _ _ _ to hold temporarily and /i i the ltody
Wnlertaker or p rson having charge of corKe) (In ove„.,.th ' •Is, uisrfe of (state how))
Dated S 1W ij.. (Signed) ----- __,--- - - --, , a►
Local Ite rar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any ,- 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 (8A2-781
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of as e it 19 `f
(Interment or
r
(Name of Cemetery, Cr
Section Lot No. /42 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.
KRAL
Owner
Mrs. Elsie Kral
Address Plot
243 Upper Sherman Ave. Glens Falls, NY 12801 Oneida
Phone # Lot #
12
Deed # Date
1577 2.6. 1980
Cost Foundation Y - N
$250.00
Location
Remarks
Record of Interments
1 6
2 7
3 8
4 9
5 10
vosS
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Li
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XRAL, Dennis M.
Age: 36
Cause: Acute Hemorrhage
Lot Owner: Elsie Kral
Lot # 12, Oneida Plot
Grave # 2
Case: Concrete
Died: 2/3/80
Interred 2/6/80
Undertaker: Sullivan & Minahan