Jones, Reese NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Ear 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 WRI1"1"EN IN DURABLE BLACK INK.
Dist. No. 5601 Registered No. aaa
Town
County Warran Village Gle.n.s....Eall.s.....H.o.s.pital
or City (If city, give street address)
Name of deceased R.e.P.S.C.....F.........Alan e.8
Single, married, widowed,
Sex Male Color White or divorced (write the word) married Date of Death.....U.e.C... 21., 19.3.6...
Age 42 Years 3 Months 20 Days Birthplace Utti.a.a.s 1I.. Y..
Cause of Death Coronary Thrombos.&.s
Certificate was signed by ,Dr v o n:T., 3heid.Q . M.D
Address {a ,?Z?$ Falls, N. Y.
Place of Burial (or Removal)
(If body is to be temporarily held, fill in space later)
Cemetery P.i..fe Vi.e.w Came.t..ry Vault Date of Burial De.a... 24., 193.6...
(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, N., ye
(Name) (Address)
the Undo rtaker to hold temporaril e in vent. •t the body.
(Undertaker or person having charge of corpse) r, ve, or otherwise ispose of [state how]) ,
Dated Dec, 2?, 1.9...5:6. (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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