Murov, Lena Form VS 61. 6-8-34-50,000 (17.7901) )
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT j
;k 's.This Permit can be signed only by the Local Registrar (Deputy or Subregistrar) of the Primary Registration District (Town, I
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. I
Dist. No./� yf Registered No. 9
Town
County F'eeex Village Ticonderoga, N. Y.
or City (If city,give street address)
Name of deceased Lena `,1 rov
Single,married,widowed, married
Sex Fer'1aleColor 7:14te or divorced (write the word) Date of Death JU.l,y 17 19 36 4.
Age 43 Years 1 Months 29 Days Birthplace New York, � . Y.
Uterine fibr ida Chr. cervlct'v.e
Cause of Death ............a 1
Certificate was signed by T• R. CU.UaIi ins, , M.D.
Address Ticonderoga, N. Y.
Place of Burial (or Removal) vleri8 Falls, N. Y.
(If body is to be temporarily held,fill in space later)
Cemetery Sat ZQY 11.£ .e. Q Date of Burial July 19 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 Harold A Scott Whitehall N. Y.
(Name) (Address)
the t ndertaku to hold temporarily a d , the body.
(Undertaker or person having charge of corpse) �J inter re 've o tlerva o o st ow )
-Vated J .Y 15, 19 53 (Signed) r
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 contmon carrier, in which case a Transit Permit (VS No. 62) is required.
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