Bleto, Mary NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 56.01 Registered No. 223
Town , ,
County Warr -Village. i f
en Tremont St. ,Glens Falls, N. Y.
or City (If city, give street address)
Name of deceased Mary Bleto
white„„Single, married, widowed,
Sex F emaleColor " or divorced (write the word) widow
Date of Death Au ., 4? 19 37
Age 78 Years ° Months 29 Days Birthplace Canada
Cause of Death Tyooarditis-15 days
Certificate was signed by Dr.. 17.m.. 1-1, Bowen M.D
Address Glens Falls, N. Y.
Place of Burial (or Removal) Town Queensbury, N. Y.
(If body is to be temporarily held, fill in space later)
Cemetery....St... Al.phons.us Came t.e.x7 Date of Burial Ages 6 4 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 A . C. Wilson Hudson Falls, N. 'f.
ame) (Address)
the Under taker to hold temporarily the body.
(Undertaker or person having charge of corpse)
..----- t , e or otherwise se of [state how])
Dated Aug.. 6.... 1937 (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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