Murphy, James Form VS. 61. 8-16-35-50,000 (17-1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
air 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. 5601 Registered No. .480
County Warren #67ale Glens Falls Hospital
or City (If city, give street address)
Name of deceased Jame s Edward kilurphy
Single, married, widowed,
Sex...Male Color lahi te..or divorced (write the v*_v_-„Qrs1) lilidOW.e.ca Date of Death De c ember 20 19 36
Age...0 Years 9 Months 2 0.f... ..Vkamp Birthplace C.anada
C e of a
Gas bacillus infection/few days- followlng ammaAtiQn of righI leg
aus Ileq,
-0 .1-v.ng e ne I r1c5' cilic 'to gr-%:IT/hh 861 e r on 8 an a dA:s:D iS Ittli.3:tt1-8""tilany
Certificate was signed by A)247..• /..0.11.n..... .. o.o.e.,L.d.Q.n M.D.
Address Glens Falls,....Ey
Place of Burial (or Removal) Two ia Town of (Zug.e.ra.bur.y
(If body is to be temporarily held, fill in space_larer)
Cemetery 6t• Alp honsu s Date of Burial December 23, 106
(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 C. Stafford Glens Falls
(Name) (Address)
the Un.de.rta.lor to hold temporarily and -Latex the body.
(Undertaker or person having charge of copse) (Inter, remove, or otherwise dispose of [state how])
Dated December 22 1930 (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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