Unknown ------- -- —
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Certificate was signed by Dr, Virgil D. S.e.11ac.k7 Health••••O•f•f••i.cer M.D
Address Gl enS Fa1.ia., N. Y..
Place of Burial (or Removal) #### Town Q.f Qae.ans.bury.., N.. Y.
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Cemetery Date of Burial sI1.1.1y 9., 19..37... •
(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. Y.
(Name) (Address)
the Undertaker to hold temporal-' n tar the body.
(Undertaker or person having charge of corpse) me . ove, is dispose of (state how])
Dated July... 9,. 19...37. (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.