Loveland, Leon , .� NEW YORK STATE DEPARTMENT OF HEALTH
- OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. ��6
Registered No.
Town, Village
Dist. No. 5601 County ',,arren or City City of Glens Falls
If city, give street address)
Name of deceased Leon F. Loveland Veteran Yes - WW II
(If veteran,give name of War)
Single, married,widowed,
Sex Male or divorced (write the word) Married Date of Death March 1 jf 19_79-
Age ='a Years Months Days Birthplace ew York State
Cause of Death Sq.uamou Cell Carcinom:. of tongue
Certificate was signed by William P. Simmonds M.D.
Address 8 Harrison Ave. ,Glens Falls, N.Y.
Place of Burial (or Removal) Town of Queensbury, N.Y.
(If body is to be temporarily,held, fill in space later) Vault March Cemetery Pine View Rec. Date of Burial 9 192_9__
(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 Regan Denny, Inc. quaker Rd.,Glens Falls,. N.Y.
(Name) (Address)
the Undertaker to hold temporarily and R.ern.o:tm the body
(Unlertaker r erson having charge of corpse) (Int ov r rwis dispo of (state how))
Dated cT �` 19_1/ (Signed) ��• e ,/
Local egistrar
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
bstt OR CREMATIONS ARE MADE
Date of ' ` was *if 19 7/
(Interment or emation
(Name of Cemetery, Ctpern um, etc.
Section Lot No. G e No.
(Signed) / .`ds4I'L
(Person in Charge)
H142# /ea& /e '
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
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.
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 tale Age(yrs.)
Leon E. Loveland � Female 59
Place of Death (indicate .whether city, village or town) Date of Death Cause of Death
City of Glens Falls 3/14/79 Ca of tongue
Cemetery now interred Location (city,town or county) Is body to be transported by common carrier?
Pine View Rec. Vault It of Queensbury,NY p Yes 1a No
State fully the final disposition to be made of body.
Interment
Norte of place or cemetery for final disposition Date of final disposition
Moss St.Cemetery,Tn of Kingsbury,N.Y._ 5/4/79
Firm Name Reg. No. Address
Regan & Denny, c. 02883 Quaker Rd. ,Glens Falls, N.Y.
'Signature of Funeral Direct° o Und gker � Reg. No. Date
/-7 04794 5/1/79
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.