Sheffer, Elmer NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Sir 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. <7 7
County Warren 44 lage Glen atreet
2/431
or City (If city, give street address)
Name of deceased Elmer E. Sheffer
Single, married, widowed,
Sex...ligi.e Color Wilit.e..or divorced (write the word) Marri.e.d Date of Death Se.pt ,
Age..7.6 Years Months 28 Days Birthplace Glens rails., 1Y.
Cause of Death Diabitis mellitis - Coma
Certificate was signed by DrA DA U.. M D
Address Glens ....N,y.
Place of Burial (or Removal) Tomn Q1 rtieen.s.bury
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Date.of Burial October 3rd , 19 '68
(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 Seward T. Potter Gleuallall.a„ . . Y.
(Name) (Address)
the Undertaker to hold temporal' nd Inter the body.
(Undertaker or person having charge of corpse) r, remov , orctrwi§g,,zLozf„..[;tel:r])
Dated OC.t Q.b.ar 10..0 (Signed)
eguty 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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