Middleton, Earl NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Mr 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. 21$
Town
County 7;arX'elt Village Olenp Falls Hospital
or City (If city. give street address)
Name of deceased Earl $.s Iili,ddl,eton
Single, married, widowed, • Married
Sex Male Color white or divorced (write the word) Date of Death July 273 .....,,.19 37
Age 4.9 Years $ Months 2 Days Birthplace Horicon, N, Y.
Cause of Death.Thrombosis left femoral vein-7 dye,Pleurisy with Effusion-6 days
Certificate was signed by Dr . Chas . F. Hawkins M.D
Address So . Glems Falls, 'Z. 7.
Place of Burial (or Removal) wiuee.>;71s..b.L1J:'y, 'i1.8.I'.C.en.. .aQ......i.i1...Y..
(If body is to be temporarily held, fill in space later)
Cemetery Fine Viaw v emat.er.X:;y Date of Burial si.1.11 j 2$a 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 . �ilson Hudson Falls , L.
(Name) (Address)
the (Undertaker
or person
to hold tempor v Inter
the body.
([.tndertakec or person having charge of corpse) r, remove, or e dispose of [state how])
Dated July 27., 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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