Harrison, Baby girl Norm Va. Di.. o-lo-S)-?U,VVV (i/-iThh
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tl 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No. 560]. Registered No. 389
Warren Town Glens Falls Hospital
CountyVillage h
Or City (If city, give street address)
Name of deceased
Female white Single, married, widowed, single Dec . 29, 36
Sex Color or divorced (write the word) g Date of Death19
Age Tears Months..l.a. Birthplace G1.atas....Falls., .N.. Y..
Cause of Death..A.SPhYXi.a due t.Q pr.Q.l.Q.ng.e.d Ve. . .a.o. ....d&..i.sl.BS' ..
Certificate was signed by D.r.. Bar.t. 5?.1.Q.r.e.vY M.D.
Address Glens Falls, N. Y.
Place of Burial (or Removal)......T ?. ._belgtueensbury, Warren Co. , New York.
(If body is c ten or ly held, t� in space later)
Cemetery1Ind View Cemetery' Date•of Burial Dec . 30,E 19 36
(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 examina-
tion, 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 HEREBY GRANT A PERMIT
to Harold C. Stafford Glens Falls, T.R...., .�
(Name) y. (Address)
the Undertaker to hold temporal the body.
(lint tak r or erson h charge of se) •.ve, or oth ose of [state how])
Datedeem�er �, 19� (Signed)..d
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.
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