Palmer, Carrie Form VS. 61. 8.16.3 5.50,000 (17.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
our 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. 5.601 Registered No A 5..4
Town
County Warren Village Glens Falls Hospital
or City (If city, give street address)
Name of deceased CArrie Cook Palmer
Single, married, widowed, 6
SexF?rflale Col 1ite or divorced (write the word)tt cried Date of Death Aug. lA l 19
Age f7 Years 9 Months 4 Days. Birthplace Kj.ngsbury s 1,• Y,
Cause of Death Cerebral Hemorrhage
Certificate was signed by C,.,A,i o r t on , M.D.
Address Glens Falls, N, Y,
Place of Burial (or Removal) Town of queensb' ry...s We:x r. n Q.Q..r..s.Naw York
(If body is to be temporarily held, fill in space later)
Cemetery . .C:..ele.y C.. mG°.t.ery Date of Burial August 4., .1..9. 6 19
(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 1L'T"♦ L. Collins Fort Ann, N. Y.
(Name) ( ddres
the Undertaker to hold tem ora ' d Inter .., the body.
(Undertaker or person having charge of corpse) (Inte ov erw. 'spose of s
Dated..A:Us L1..,..:�e 5.,......I,.9.5.0 19 (Signed) C.
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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