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Kennedy, Ida a VS. 61. 8.16.35-50,000 (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 ......, Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CE DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist. No...5.6.01 Registered No.-- -._ao 3D h Town County ``7arren Village Glens Falls Hos2ital �- or City (If city, give street address) i Name of deceased IJZa a .1„1, ........ Ke.m .dy Single, married, widowed, . Sex Fenial� al i gr divorced (write the word) di .._re�.d. Date of Death ;i.QV.e.1aLkar ..p a !... Age QO Years Months 7.4.1 Days Birthplace.... ,: ,ke CxG.o.r.ge..' .i:d.a I.... Cause of Death (E.1.s.tr.o..sl.:kte.ti..t.i.s Certificate was signed by Dr... JD.'.iL.i.gh.:kt 'lc -.ai:l':; :e.r M.D. Address G1.e.ris Fa.1.iz , . .. Y.. Place of Burial (or Removal)..T..Q Lf Q' QI p.0..nSbi..r.'; .+ 'a.r..r.Qn. u.Q.....'.2.e.l York (If body is to be temporarily held, fill in space later) .T Cemetery '... H.t..a aX'LuafQ.e v y'. :te.1.e Date.of Burial yt©.r. 227 1 .....4 (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 .r.1..( 1 to 1iaruld 4+t 9Y.N.4cf-fc . ...F .. ns Falls.., n: . 7a (Name) (Address) the Un.d.e.r.t.ake.r to hold tempora ' n .. 'a..-. ..: the body. (Undertaker or person having charge of corpse) (Inte e, or otherwise dis se of [state how]) Dated iT.Q.VI.a 21, 19.. G. (Signed)........... ... 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