Cameron, David h. „,v of triev. (II ) IN/VW TUrIC JldlC Ut.pdrLi neIIt VI rivdutII
BURIAL — TRANSIT PERMIT
Name: First Middle Last Sex
David D . Cameron Male
Date of Death 1 9 8 2 Age 7 3 If Veteran of U.S.Armed Forces,War or Dates '
F, Feb. 2 1 ,
WZ Place of Death CCit',lTownOor Villaged , N .Y . Hospital, Institute or Street Address
WCauses of Death:
U
WA Medical Certifier: Name Title Address
/
Death Certificate Filed:City,Town or Village 'i District No., Register No.
Ballston Spa, R .Y .
Burial: Date Cemetery or rematory Address
0 Cremation: April 23 , 1982 St •A1 nsus Cemetery Tn of Queensbury, NY
Removal Date •lace Rem and/or Held Address
0 ❑ and/or Hold:
E,
QTransportation by Date ç, .Point of Shipme Destination
a ❑ Common Carrier: A Y;
rn
A Date • •metery Addr, s
Disinterment:
0
Reinterment: \
Permit Issued To:Na . Funeral Firm 1 Addre s Registration No.
Re • an & D-n� Inc . y ker Rd . ' lens Falls NY 02883
Name of Funeral Fir \�.aking Disposton .r to Whom Rem, s are Shipped, If Other Than Above: .
F- Address: \ - _2
aPermission is hereby grant-d to dispose of the dead human remains described above as indi ,.i` c `j��W Date Issued t (- J�
p Registrar of Vital Statisti s (Signature)
District No. ,) C ''-� \)^rs� ' � t-o�!
Place 1
his permit must be completed on back by the person in charge at the place of disposition and filed with the registrar of vital statistics of the city,town or village
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 accompaniedpy 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.
I certify that the remains were disposed of in accordance with the permit on the reverse side on 14 23-82
(Date)
at St. Alphonsus Cemetery, Luzerne Rd. & Pine, Queensbury, NY
(Place of disposition and address)
•
Section SP• C Lot No. Grave No.. 5
Signature Title Pastor
BURIAL — TRANSIT PERMIT eivti i I
Name: First Middle j. Last Sex
Date of Death Age n� If Veteran of U.S.Armed Forces,War or Dates
F- .2/'?i /i Y �?
z Place of Death: ity,ToGvn or Village Hospital, Institution or Street Address
A 0i9//5 fG,V 5e6q. 6i�R�Tv 6 a Co Ccnvey 1-1YF�'R/hi t
W Causes of Death: 6-/ / ��� / / T /�
U �t�u�n ` 1`ta�X 0.� IC,a�ut
W Medical Certifier: Nagle Title Address
Q H. 5Cifg rY in, P, U Pf3 4 //STary i4-7/1-5-/a,/f
Death Certificate Filed: City,Town or Village District No. Register No.
Date Cemetery or Crematory Address
❑ Burial:
O Cremation:
k,r Removal Date Place fRemoved and/or Held' � Address
-mot and/or Hold: ,�ja q 7 pt e_ V J . V - f M• Q J
r~/i Date Point of Shipment Destination
Q Transportation by
Al. ❑ Common Carrier:
rA
A Date Cemetery Address
Disinterment:
El
Reinterment:
Permit Issued To:Name of Funeral Firm Address Registration No.
Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other Than Above:
F-. Address:
c4Permission is hereby granted to dispose of the dead human remains described above as ind ated LI
a Date Issued !' 'a.0 X "" `i
Registrar of Vita tatistics (Signature)
District No.
Place
his permit must be completed on back by the person in charge at the place of disposition and filed with the registrar of vital statistics of the city,town or village
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 accompaniedpy 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;orother disposition shallkeep 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 on the reverse side on (4`/
�--� — (D 71
e)
at gem,aito„
(Place ofisposition and address)
Section Lot No. /*MZ/Grave No.
Signature •i( ��L� � Title
Form VS-tf'(rev. 11/65)
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY
In completing this form, please typewrite, hand-print or write legibly all entries in permanent black or blue black
ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN"
in applicable spaces.
I hereby request permission to disinter the dead body of:
Name of Deceased Male Age(yrs.)
DAV I D D. CAMERON Female 7
Place of Death (indicate whether city, village or town) Date of Death Cause of Death
BALLSTON SPA, N .Y . 2/21/82
Cemetery now interred Location (city,town or county) Is body to be transported by common carrier?
PINE VIEW REC ,VAULT TN OF QUEENSBURY 0 Yee RNo
State fully the final disposition to be made of body.
INTERMENT
Nance of place or cemetery for final disposition Date of final disposition
ST, ALPHONSUS CEMETERY, TN OF QUEENSBURY APRIL 23,1982
Firm Name Reg. No. Address
REGAN : DENNY, INC , .32883 QUAKER RD„GLENS FALLS,NY
Signature 04 nera •irecto or Vndertrtker Re . 'o. Date
- --- QL4 94 - APRIL 2341982 _
INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER:
1. See Section 13.1 (formerly Chapter XIII, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies
by common carriers, as printed on the back of the Transit Label.
2. The data required concerning the decedent may be obtained from the local register or cemetery record.
INSTRUCTIONS TO LOCAL REGISTRAR:
1. For bodies to be transported by common carrier, fill out Transit Permit.
2. For bodies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit.
3. In each case write the word "DISINTERMENT" on the Permit.
4. This form should be filed and carefully preserved in your office.
.,-. j