Ball, Winnie NEW PORK 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 CERTI•FICATE OF
DEATH, LEGIBLY WRI I 1bN IN DURABLE BLACK INK.
Dist. No....5.601 Registered No. 1.74
Town
County 7.1a..X.:;C'.e.n Village M.o..°Imer Miming....Homan'
or City (If city, give street address)
Name of deceased anfi.e Bail
Single, married, widowed, •
SexFemale Color white or divorced (write the word) married Date of Death June 3, 19 37
Age 57 Years 9 Months 24 Days Birthplace Vergennes , Vt.
Cause of Death Qhroni,a Mygeard .t.is-4 MQs.,..,.Fa. .e1.y..e Con.ges Ign of lung,71Q day.s
Certificate was signed by Dr, MR L. Hava. ,a,r d M.D.
Address Glens Falls, N, y,
Place of Burial (or Removal)toki+e. .t Gi .x1$ Fall..s.., N1... Y....CfrOm Glens Falls Cemetery)
(If body is to be temporarily held, fill in space later)
Cemetery West Glens Falls C.o.m.at.eiry Date of Burial JAMS. 19....37.
(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 Lionel J. 3oivin Glens Falls, N. Y.
(Name) (Address)
the Undertaker to hold tempora ' i t•e.r••(•• ....Ra'n.ter) the body.
(Undertaker or person having charge of corpse) n: ve, or herw e spose of [state how])
Dated June 1.54 1 . 19 (Signed)... ... ..
cal egistru
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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