Allen Jr., Bruce YV cI kl Icy. I I I JJ 1\G1111 I VIM Vtalc VGtlOI LI IIGil It JI I I�(Al NI
BURIAL — TRANSIT�EyRMIT
Name: First Middle (�(/Lam Sex
Date of Deat ge y�{ 7 fl Veteran of U.S.Armed'Forc� ci
es
WPlac f eat6 City,T nor Village Ho ital, Institute r Stre ddre
W es of Dleaath:
W di eifie4— - "��1 o 94,1 Title Add e
i � —'E�5 ,►� ��G_
a i i to Filed: o r�or':illage f r' No. Register No.
Date J� , p® meary or Crematory ! Address
/ C rem / ` o // -t?r►t %�� '
0 Cremation: �-�� �/-�� , ��
z 7
Removal Date Place Removed and/or Held Address
O ❑ and/or Hold:
F-1
rn Date • Point of Shipment Destination
Q Transportation by
a ❑ Common Carrier:
0
A Date Cemetary Address
Disinterment:
0
Reinterment:
Perm Issued o:Name of neral Firn1' Add ess Registration No.
eral irm Ma n i positio or to Whom Remains ar Shipped, If O r a o
F. Address:
c4Permission is hereb grante to dispose of the dead human remains described abov as indi ated
W Date Issued yd .e/"�
p ) /9 J R istrar of Vital tat' . s (Signature) c'%% .
District No. .5 r4 el
Place
`his permit must be completed on back by the person in charge at the place of dispositi eda
e regis ar of viers atistics of the city,town or village
where disposition took place.
.1111111.11.w—
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 py 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.y
I certify that the remains were disposed of in accordance with the permit on the reverse side on // ��
(Date)
s !
at
(Place of disfosition and address)
'1 '
Section Lot No. / 7 Grave No. 9
Signature Title
NAME Allen , Bruce James
Age: Stillborn
Cause:
Lot Owner: James G. Fisher
Lot # 157 Oneida
Grave #
Case # Styrofoam
Died: 7/1/80
Interred: 7/3/8 0
Undertaker: Sullivan & Minahan
FISHER
(1(7''t)
Lot No. 161,162,175
Address 2 Garner St., Glens Falls, N.Y. Section 1
o.
Owner James G. Fisher Sr..& Peggy J. Fisher P
Oneida
Date 7/27/77
600 Superficial ft. @2.50 per sq. ft.
Location Bounded on the North by Path, East by Path, South by Savale,Bowman, Fitzgibbon, West by
Road, Savale & Bowman
Corner Posts
Remarks The Deed listed below replaces Deeds #1408 & 1416 which have been voided.
Deed No. (and changes) di5
Payment Record Paid in full 7/27/77
i 1
t
Form No. 01
Record of Interments
1 _To roc.s -FiSkce- Se. /D•/0- Oa 1 5
2 'Pc-?.?/ F-s l-,<-1, ev - I . a D 6 1
s I ,2ms r�s la c.,t .Te - Lo- 7. 7 7 . 7 • C-f 12/4A-/i[t' f I /r_2 (21d2
4 1 ! 8 I f3 Al -1k,
i____________________. .gc i 77 I) -r /
/ . d
O
8 -2-
ti_
, t, A \X \ ,
it l' I /e '
1
5 LP ���
i
4-
1 4 -
\nn
•
I
-1 w
i
1