Clarke, Joseph roam vJ. Os. 8.10-5J•7u,vuu 11/•1145)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sue'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. 5.60.1 Registered No
Town
County.`it rrpn Village74 Hudson Ave . ,Glens Falls, h. J.
or City (If city, give street address)
Name of deceased Joseph E. Clarke
Single, married, widowed, Is7arr 3`1 37
ied
Sex Mile Colorym1 to or divorced (write the word) Date of Death 19
Age..G Years 1 Months 9 Days Birthplace S1.ens...1..a.l.ls , .... `�.........._....
Cause of Death Diabetus Mellitus----4 years
Certificate was signed by .Dr... Floyd .Pallier M.D.
Address Glans Falls, ILL.. Y.
Place of Burial (or Removal) T.Q.:.11 e.a Qu.G..eCls.. .]aZ'�?.� 71e.at Glens Fa1a 5.fi N. Y.
(If body is to be temporarily held, fill in space later)
Cemetery `7 st Glens Qemetery Date of Burial 3-3- 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
Will Carlton H soil Falls , N.
(Name) (Address)
the Undertaae' to hold temporal.' ter the body.
(Undertaker or person having charge of corpse)
Int move, or otherw ose of (state how])
Dated March a. 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.
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