Hoffman, Conrad Form VS. 61. 8-16.35-50,000 (17-1423) ""'
NEW YORK STATE DEPARTMENT OF HEALTH F-1' -
OFFICIAL BURIAL (OR REMOVAL) PERMIT
M`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. Registered No.
aalYn Falls
County Warren ATalage 8 Bacon St. ,Glens
filF.City (If city, give street address)
Name of deceased Conrad R. Hoffman
Seale Colorwh1 to or divorced
r(wri el the we
married Date of DeathFeb. 9th 1936
Age 55 Years 10 Months 18 Days Birthplace Selkirk, T.Y.'
Cause of Death Carcenoma Descending Colon
Certificate was signed by LeRoy J. Buti.O ' M.D.
Address Glens Falls,N.Y.
Place of Burial (or Removal) Pine View Cemetery Vault
(If body is to be temporarily held, fill in space later) 'Febra ary 11, 19 36
Cemetery Date of Burial
(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
(Name) (Address)
the Undertaker to hold temporarily and place in vault the body.
(Un efta er or person having charge of corpse) (Inter, r m therwise d' se of [state how])
Dated e"5ruar�T 11, 19 36 (Signed)
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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