Wilson, Julia Form N.. 61. 8-16.35-50,000 (17.1423)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sti "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...s.6 O /
Registered No. 2 -
Town ��/ ff_ £ Pl ��
County a-1-" e-, — Village //z �( r� t�tih r t
/� , or City (If city, give street address)
Name of deceased ..... (�' /�'�
�� _ Single, married, widowed, , Q.
Se .. Color... . 7�+/�-or divorced (write the word)1�1��%�'�`� Date f De th Z/...19.. 6
Age , Y rs 7.--- Months 7 Days Birthplace. f ih. .i.... -- .
Cause of Death k Tra-e 7 . . .
Certificate was signed by6 j2C`-4.... A• 3- M.D.
Address ., je .77 '� �"1 r
Place of Burial (or Removal) `/��/f% ,/ 21 1-
(If body is to b t mporari}y�ld, fill in ace lat
Cemetery..... .�1. s/ Date of Burial • Z 'f,! 1926
(If body is to be temporarily held, fill in space later)
• The Certificate of Death containing the above stated particulars, having been pres ted to me, after careful examina-
• tion, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
7') I have accepted the same for registration, have recorded it in my Local Record with the above// stated Registered Number,
• and o the basis thereof I EREBY GRANT A PERMIto eT ���:Zih2l
N e.. .. ess)
the
to hold temporarily and the body.
(Under er or person having charge of core se)
(Inter, re ise dispo [state howl)
Dated . - ? 1 19.., . . (Signed)
Local Registrar
This ermit 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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Fora-VS No.87. 8-20-25-5)00 (21-1315)
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER'S REQUEST TO DISINTER BODY
tar'See Rule 4, Special Administrative Rules Relating to the Transportation
of Dead Bodies by Common Carriers,as printed on the back of TRANSIT LABEL.
N.B. If the disinterred body is not to be transported by a common carr
ie
nevertheless this Request should be filled out and Permission for Disinterment
rt
requested as below.
I HEREBY REQUEST PERMISSION TO DISINTER the dead body of
_A„ Wilson , who died in the * City-
of e s
On
, Sex_ __'._ -� itv.YiNave,Town) �. �.
u Lei �e
Color or race * ''`i t e , Age *
years, and Cause of Death * Cerebral
'.Uc..r�1it .e. NOW INTERRED IN_ Pine z;i ew 0e me t e ry
(a) The body is to be TRANSPORTED BYAmtwort 771e2rse anct. fan May 2,193o
Interment nion rye _ ete ;v
(State fully the disposition to be made of body) at o r! e n Henry,9 .em
(b) The body is NOT to be transported by Co moron Carr(Nameofier dace or c but is toe to)
be
at L'
(State fully the disposition to be made of body)
(Name of place or cemetery)
(Signature of undertake )-
Dated4 ril 7th) 19 Address Glens Falls,,,-.Y.
License number 5302
APPROVAL OF HEALTH OFFICER
Dist. No
I HEREBY APPROVE above Request a recomme t t Permissi be granted.
(Signature of Health Officer)
Dated April 19 33 /
rInstructions to Local Registrar: Fill out (a) Transit Permit for bodies
transported by Common Carrier or (b) ordinary Official Burial (or Removal)
Permit for bodies not to be so transported, in each case writing the word
"DISINTERMENT" on the Permit. The data required concerning the decedent
may be filled in from the local register or cemetery record, writing "Unknown"
as indicated by (*) when the data can not be obtained.