Brunelle, Alfred NEW YORK STATE DEPARTMENT OF HEALTH
—.- OFFICIAL BURIAL (OR REMOVAL) PERMIT
ESP 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. 19
Town, Village
Dist. No. 5657 County WARREN or City VANDUSEN RD.
If city, give street address)
Name of deceased ALFRED F. BRUNELLE Veteran YES WW2
(If veteran,give name of War)
MALE Single, married,widowed, MARRIED 3—3 1— 8 0
Sex or divorced (write the word) Date of Death 19
Age 6 3 Years Months Days Birthplace N N.Y Y.
Cause of Death CARCINOMA OF BLADDER
Certificate was signed by HARRY D E P A N JR. M.D.
Address GLEN STREET GLENS FALLS , N.Y.
Place of Burial (or Removal) TOWN OF QUEENSBURY
(If body is to be tempoT• „ily 1beLd 4-3—fill in space HONSUS later) O
Cemetery D Date of Burial 198
(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 J . CRAIG SULLIVAN 67 PARK ST. GLENS FALLS , N.Y.
(Name) (Address)
the UN.D.ER.TAKER to hold temporarily and _-__ -_. STO _AGE._____ ___ _... the body
(Unlertaker or person having charge of corpse) (Inte , r ye r otherwis d' p e of (sta •w))
Dated 4-3— 19 80 (Signed)
Local Ite ar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any p 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. 6/631 (8A2-781
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 ^ �--- /i))7 EI Male Age(yrs.)
/✓�Z.L:7 � ,-C'-Z_, ❑ Female 6
Place of Death (in icate whether city, village or town) Date of Death Cause of Death
/at-64'-1-1 �c c�e —� d .thi/s-G'
.Ce etery now inte ed location (city, town or county) Is body to be transported by common carrier?
//< /' ❑ Yes �(' N o
�Gd�.-zZtzt C I�GLC,�7//'. C� ,G{.kE _>v2�t +� Yes
State full4 the final disposition to be made of body.
Name of pia",or cemetery for; nal dispositil Date of final disposition
Fiirff,Nareee� Reg. No. ) l Address
7es ,///ma`s //J C y'
Signet ooff"4uneral Director or, ndertrtkeer. Reg. No. ( Date
e S3i 0
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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.