Noreau, Josphine Form VS. 61. 8.16.35-50,000 (17.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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. Registered No
5601
317
Town
Warren 26 First St. ,Glens Falls , N. Y.
County Village
or City (If city, give street address)
Josephine Moreau
Name of deceased
Female .rTtiite Single, married, widowed, Married October 20, 19 36
Sex Color or divorced (write the word) Date of Death
75 7 Huntsville r• Y•
Age Years Months 29 Days Birthplace -, I N.
Cause of Death Carcinoma of Right Breast
Certificate was signed by .Dr q Harry. Depan M.D.
Address Glens Falial N. Y.
Place of Burial (or Removal) Glens Falls. N., Y.,
(If body is so be temporarily held, fill in space later)
Cemetery St . Alphonsus Cemetery Date of Burial Qatatuar 25, 19.3.6...
(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, o
and on the basis thereof I HEREBY GRANT A PERMIT
Lionel J. Boivin Glens Falls, N. y,
to
(Name) (Address)
the Undertaker to hold temporaril the body. „i°
(gndertalter or person having charge of corpse) or otherwise ' tate howl)
Dated 1/4./c to o e r az, 1936 (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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