Fredette, Myra NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
I 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. 5 3
Town, Village
Dist. No. County Warren or City amity of Glens Falls
If city, give street address)
Name of deceased Myra V. Fredette Veteran
(If veteran, give name of War)
Female Single, married,widowed, , dQ1.1ed Jan. 257
Sex or divorced (write the word). Date of Death19 9
Age 70 Years Months Days Birthplace _-_,. _::_1_Ont
Cause of Death Baeilar--_artery_-_t_hrambo.sa..s
Certificate was signed by Denis NA...Ltd..j.gnan M.D.
Address 90 South. St„ lens {a1..],a_,.__.Na_.L_a
Place of Burial (or Removal) Town of Queensbury,i N,Y.
(If body is to a tempor jly held,fill in space later)
Cemetery Pine Vies' sec, Vault Date of Burial Jan 30 1979._
(If body is to be 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 accepted the same
for registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE-
BY GRANT A PERMIT
.
to egan Denny, Inc. :quaker Rd. ,Glens Falls, N.Y.
(Name) (Address)
the Jn'i n r t,` '=,e r to hold temporarily and RefQve the body
(Unlertaker or person having charge of corpse) (Inter, remo e, or otherwise dispose of (state how))
Dated - ,-. . 19 (Signed) \�, G. .�
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)(7A2-53)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of ) 5 was / 19
(Interment or Cremation) r/
(Name of Cemetery, —
� r .-r
Section Y 41.-- t � Lot No. Grave A.
(Signed) -
(Person in Charge)
Address /2. 7 /1%
i�
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.
s- 'Ywrn 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: -
Nome of Deceased n Male Age(yrs.)
Myra V. Fredette °S� Female 70
Place of Death(indicate whether city, village or town) Date of Leath Cause of Death
City of Glens Falls, N.Y. 1/25/79 Basilar artery thrombosis
Cemetery now interred Location (city,town or county) Is hody to be transported by common carrier?
Pine View Rec. Vault Tn of Queensbury,N. Y. 0 Yes gX No
State fully the final disposition to be made of body.
Interment
Kane of place or cemetery for final disposition •Date of final disposition
Northfield Cemetery, Northfield, Conn. 4/17/79
Firm Narce Reg. No. Address
Regan & Denny, Inc. 02883 Quaker Rd. ,Glens Falls, N.Y.
;Signature of Funeral Director or Vndert, cer �� -•'77 -
'`%fy .r Reg. No. Date
,^� / -- 04794 4/16/79
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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