Boucher, Mary NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Bir 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. 156
Warren Town 67 Broad St . ,Glens Falls, N. Y.
County Village
or City (If city, give street address)
Name of deceasedkary A. -Boucher
white Single, married, widowed,
Sexf emale Color or divorced (write the word)....S., XAgl.e Date of Death May 18, 1937
Age 62 Years 10 Months 15 Days Birthplace....Glans Falls., NA Y.
Cause of Death Carcinoma left breast--5 Mo.
Certificate was signed by Dr. Harry Depan M.D.
Address Glens Falls, N.,...... i
Place of Burial (or Removal) We.S..t Glens....F..al.ls.,....11. Y..
(If body is to empor �ty held, fill in spare later)
Cemetery -' e Alptlonsusw Cemetery Date of Burial May 2Q.s 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 Seward T. Potter Glens Falls, N. Y,
(Name) "law (Address)
the Undertaker to hold temporal' ; .n•,,.. ;,,,.. er the body.•
(Unttertaker erson having charge of se) "(Inter, t, ve, or ot• •ose of [state how])
Dated l`18•7 , 19° (Signed)-.. � ' g...,,1
Ap-
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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