Mc Innes, Violet ' NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Vilrage, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village Registered No.
Dist. No. Co,..) -.) County or City ,k.e ,-,
f city, give street addres
Name of deceased •�..t Veteran
(If veteran, give name of War)
Single, married, widowed,
Sex .r" or divorced (write the word) Date of Death ti- 1 19
Age L.1,4 Years Months Days Birthplace
Cause of Death Ltv -r-yr-r. k) a'`Y� f- "
Certificate was signed by �J M.D.
Address
Place of Burial (or Removal) &'7{' it� Vt---4.
(If body is to be temporarily held, fill ins ace later) /
Cemetery -ems ate of Burial G' d. C� 19 y
(If body is to he temporarily he , fi i s ce later)
The CERTIFICATE OF DEATH containi th •e state rticulars, having been presented to me, after careful examination, the
same appearing to be COMPLETE, COR D S FACTORY AS REQUIRED BY LAW, I have accepted the same for registra•
tion, have recorded it in my Local Rec . •ith above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
(Nam ) _ (Address /y
the to hold temporarily and ,,,e,,,, the body
(Undertaker or person ha ing charge ofcorpse) (Inter,`remove, or otherwise dispose of (state how))
Dated cI (Signed) 3-i--�-� c' -t,,�
jJ Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part 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) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 4P/`(L was 19 /
(Interment or Cremation)
(Name of Cemetery, Crematorium, etc.) C24/kWL0-'
,it ,S Z'
Section Lot No.3" Grave No.
(Signed)
(Person in Cha )
Address ,"--" )57A7e-�' ` c
°rid, 1,41 L /17/ 5
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 UNDER-
TAKER 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 UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fa' 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 C�RRT,IFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. �JC�
giste d N
Town, Vill
Dist. No.- Ul/ Coun alp -7-4.--- or City ? (./ - L
v (If ci "ve sheet address
Name of d eased . /„,�+ G� t1 '274 Veteran j
(If veteran, give name of War)
Single, married, widowed, G
Sex , . .. or divorced (write the word) oAe ec Date of Death . 1 — ( ixo. 19 y....
Age.. d Yer42 s. Months ays irthplac ..
Caus of Death .......... � /
Certificate was signed M.D.
Address Lid7 _ , /2 - �1'
Place of Bur' or Removal ....,. .
(If body is t beAemtporari%y ►pe d, (ill. in ace later) )
Cemetery �i.'..jG.-i--�.� L✓A -� L/ Date of Burial f— G 19 '�
(If body is to he 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 acce ted the same for registra-
tion, h recorded i i my Local Record with the above stated Registered Number, and on t e basis t e eof I HEREBY GRANT A
PER /,f � /// '
to ....
/ (Name aciress)
the .. . to hold temporarily and LV z, the body
(Undertaker or rsoryhiaving charge of co se) Inter, re�gv�e, oty�t�hey�►sietdspose of (state how))
Dated .. — ..s 19 ....�. (Signed) !/`. OK�+`'
Locr;.Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of t,.e 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. (ItI V. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of [ l/ ' ' was 19//
(Interment or-Cremation)
(Name of Cemetery, Crematorium,ettc(.)
( : ‘Section Lot No. Grav o. - 2
%
(Signed) ' _ ; 1 2 7 '
(Person i 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 UNDER-
TAKER 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 UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.
Form VS-67 (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:
no. of Deceased Male Age(yrs.)
Violet McInnes Female
Place of Death (indicate whether city, village or town) Date of Death Cause of Death
Glens Falls, N.Y. k11r7)1 Carsnma nf Am-n1,11 a of
Cemetery now interred Location (city,town or county) Is body to be transported by common carrier?
Pine View CM Vault Twn Queens'nurv, NY 0 Yes No
State fully the final disposition to be made of body.
to be intered
Name of place or cemetery for final disposition Date of final disposition
iwave nes Como�ory
Oak3-81 , ae4 April 20, 1Q7t,
Firm the Reg. No. Address
Potte, neral Sermi e 81Q7)l 13() Warren St Glen '7'a11s 7.Y.
[signature i neral Director Un * ke Re . 1te '
A0 11 2 April is , 74
•
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. Tbis form should be filed and carefully preserved in your office.