Andrews, Peter rurm ♦0. US. 0-10-2 J•Jv,vuv tr/•1YLaJ
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 5.601 Registered No..3..2
Town
County Warren Village....1.39 3.o.u.tt 'a.1.I..s., LT... Y....
or City (If coy, give street address)
•
Name of deceased '..e.t. .X' Andrews
Single, married, widowed,
Seale Color White or divorced (write the word)..$.a..l± gLe Date of Death Jan... 74. 19 37
Age 65 Years 7 Months 7 Days Birthplace So... G1.e.n.s...F..a� 1. ..} ...Y..tt
Cause of DeathBr0nchitis-LaGrippe
Certificate was signed by Dr. Harry Depan M.D
Address Gle,f?a Fella, N. Y.
Place of Burial (or Removal) West Glens Falls,,N.YR
(If body is to be temporarily held, fill in space later)
Cemetery 5t , 1 phQf; Q.S Q.e.ifl. .tt.e.x y Date-of Burial 11., 1.9.37 19
(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, Y,
(Name) (Address)
the Undertaker to hold tempora and I al' '"" the body.
(Undertaker or person having charge of corpse) (In pot, ise dis [state howl)
Dated Jan. 9, , t _19. 37 (Signed),.... dye
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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