Sprague, Laura rorm vo. 01. 6-16•35.5U,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 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. JQ8
Town
County '+Darren Village G1.ens....F..a1.l.s Ho.spttial
or City (If city, give street address)
Name of deceased Mrs• Laura Sprague
F@mal Single, married, widowed, .
Sex color white or divorced (write the word),..A:s'krri.e.d Date of Death...D.C.t... a 19...35
Age 62 Years 0 Months 16 Days Birthplace unknown ,State of Maine
Cause of Death Mi,tral RegI,I,x'g,j,t, ,, io.n,
Certificate was signed by Dr. B. J. Singleton M.D
Address Glens Falls a iv. Y.
Place of Burial (or Removal) azes.t z.l.e.22S....F..a1.1s.y.....1T.. Y.
(If body is to be temporarily held fill in space later)
Cemetery 'lest -lens Falls Cemetery Date of Burial Qct.o.h.er 11., 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,
and on the basis thereof I HEREBY GRANT A PERMIT
to Orville W. Collins 16 Main St .,. ..R. C, ,.l. ..i L. 11.
(Name) /.n, (Address)
the Undertaker to hold temporar..0 r,� the body.
(Inter, ..s v 'r
(Under ker or arson having charge of corpse) � y��,�i or otherw'se di po of' [state how])
Uctober - '
Dated 9, 193.6... __ (Signed) i� � • ..*.. d/>.
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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