Hurd, Garnet 'IN NEW YORK STATE DEPARTMENT OF HEALTH
` OFFICIAL BURIAL (OR REMOVAL) PERMIT
I4P 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. 7
J Town, Village
Dist. No. _ L�/ ounty 61- or City
If ci gtY'1Ve street address)
Name of deceased /'� 7�rzes- . /4-e'-f-i.een Veteran
(If veteran,give name of War)
Single,married,widowed, //,'� �
Sex _(/ - or divorced (write the word) `� € ^--1,./. Date of Death __‘0 ,/ 192,2
Age _4 -��� ears Months Days Birt ____ /'
E.. , ��� G ts.cz_ r
Cause of Death � _ - .fir
Certificate was signs y __- ___ __ _ 51,..t...,._XY1 - ,j. i M.D.
Address qr.) �' -,.-.-- "f
Place of BJ� (or emoval) c _�..p ' , _ _
(If body is B. b orar held, fill n ace la ) `
'Cemetery �-�"e.,- O- J--F Date of Burial — 19._ ..
(If body is to be temporarily held, fill n 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 accepted the same
for registration, have recorded it in my Loca Record with the above staated Registered Number, and on the basis thereof I HERE-
BY NT A PERMI � r '
t0 Name) ' fy
( Atldressf-�
the to hold temporarily a the body
( nlertaker or pea- on having charge of co ( e remove, oef wi7J�µsgos of t how))
Dated y -)' 19 _2 (Signed) -_.____ __ _ _._ f ^ /fk�YQ-
Local Re 'str
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) (6A2-130)
• ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
t. OR CREMATIONS ARE MADE
k/
Date of was 19 7
(Interment or Cremation)
(Name of Cemetery, rium, etc.)
7
Section Lot No.o. Grave No.
(Signed)
(Person in Charge)
Address �j ./eGe'
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.
a a.
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:
Name of Deceased
Male Age(yrs.)
Garnet G. Hurd Female 56
Place of Death (indicate whether city, village or town) Date of Death Cause of Death
City of Glens Falls, N.Y, 8/5/77 Heart attack
Cemetery now interred Location (city, town or county) Is body to be transported by common carrier?
Pine View Rec. Vault Tn of Queensbury,N.Y. ❑ Yes }, No
State fully the final disposition to be made of body. zs-
Interment
Name of place or cemetery for final disposition Date of final disposition
, Hyland jer;. ,':eFt Woodstock, Vermont 8/19/77
Firm Name Reg. No. Address
Regan & Denny, Inc. OP883 Quaker Rds ,Glens Falls, N.Y.
Signature of ne 1 Director nde/raer k
i� Reg. No. Date
. 0-c Xc- i ��Lc 1 T 07355 8/18/77
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.
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