Godette, Lena rvrm va. cr... O-AU-))-)V,VUU (I/-14t3)
NEW FORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
•
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..... Registered No. :5 52
z,lar-ren Town 11 eeond dens o11s N. Y.
County Village a i
-- or City (If city, give street address) •
Name of deceased Lena Gode t t e
F e mal .yh i t eSingle, married, widowed, t tT r ^
Sex eColor or divorced (write the word) ; � c o 'ed Date of Death o ember 2Y 19•-'°
Age 68 Years 4 Months 0 Days Birthplace Greenwich a . -
Cause of Death Coronary Thrombosis
t k a .
."Certificate was signed by.... o....a...•....*Li. d,y 'h1k..� IVI b-:
Address hadson Falls ". Y.
Place of Burial (or Removal) Town of Queensbury a Warren Co . G3xew York,. .
(If body is to be, mp,r it held, fill in spa later z
Cemetery `TJ ?i )honsus ueme`'erJ Date of Burial November 271 19 36
(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
e w a r d T. Tot or Glens Falls,'`. `'. •
'(Name) (Address)
Undertaker
to hold temporaril 7 1:.ah the body.
(Undertaker or person having charge of corese) `. emove, or oth�. e dispose of [state how]) •
i overifber '` D� 1 / i
Dated x 1.9 (Signed) �, ,i •
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremati.n) 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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