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Hermance Jr, Frederick corm VS. 61. 8.16.3 5-50,000 (17-1423) NEW YORK 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. 3.6.tQI Registered No. 314 Town County Warren Village 20 Mission St . ,Glens Falls, N. Y. or City (If city, give street address) Name of deceased Fred.. j,cls, V, e1e Hermance, Single, married, widowed, Sex Male Color 'thiteor divorced (write the word) aingle Date of Death October 18,19 36 Age Years Months 6 Days Birthplace Glens Falls, id , a . Cause of Death QQ.a .enttet r Heart pisea e-6t ays Certificate was signed by Dr. Saul Yale. M.D. Address Glens Falls, N. Y,1 Place of Burial (or Removal) la.eti Glens Falls, ,... , y„ (If body is to be temporarily held, fill in space later) Cemetery ;lest Glens Falls Cemetery Date•of Burial QcZQber 20, 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 Joseph F. Regan Glens Fails, N. Ye (Name) Adak (Address) the Irnd.e.r.t.alie.r to hold temporarily ,.t` the body. J� .i°! (Undertaker or person having charge of corpse) otherwise ,. o' [state how]) Dated C�}Ct�o1�Q.l' Q.., 19.. . 1.. ,(Signed) i�� /` i 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 r other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. N \ ✓ r i OEab9 v iU"a3" 0 v' O c!•7 ' c"`^ n—"'Oi. a: sOg y"O v O..,... GOC .:.' O O.5� R .Y,.y ">,O y,q O .na� O U v� Is+ C am y F O 4,,,,:t:v)Z „ oa) OE 7 cd... y ° C . w O•� Cd ' ` a> n> 3a C X, ,., yv !>� f� a � 3r > '- i v , i ooyoa � � va aA- 5 vo ° d ° � > a "".� a� vNvy 1 > o , a� oa '• . aip "o` fv � E otdas = -o . ^-0 a v w a d • SA a' P0 0 % ti u , Q y vO o Oau ; N47a cw vwO .5O a a• Ua)O" vy-v4s 'i � . yy a a.. O >p mW a W G � - w ° O.o 5eto•n ., a pO 0 i "T u O ZO a� ` ^C• ° ° ° am' .0 H • 01 wCD Y •-, b0 " v,X ' U W0 V 0 d '0 0 y, v.. , _IS 3`�•.a-. ; ° . v a id w ,�"' 3,.0 o v ,. 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