Carter, Mary 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......2.96
Town
County r. ,.X . .Kl Village. Glens....Fa,l.1.s...s:Io.s�la.z•tal
or City (If city. give street`address)
Name of deceased Mary C.a.Q..Q.I.ia Gr v.er
Ferale wh to Single, married, widowed, widowed Nov.
Sex Color or divorced (write the word) Date of Death 4 19 37
Age 69 Years 8 Months 9 Days Birthplace A.1.Ii9.110..4 T.* Y..•
Cause of Death cerebral hemorrhage-3 dys.:fract. rt. femur-5 dys.
Certificate was signed by Dr... J.ohn...H.. Sheldon. M.D.
Address Glens Falls, N. Y,
Place of Burial (or Removal) We s t Glens Fa 11 s s N, Y.A
(If body is to be temporarily held, fill in space later)
Cemetery at, Alphons.U.s Cemetery Date of Burial Nam.. .6.,. 19 3.7
(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 Loren i, Singleton Glens F.all.s.., L... Y.
Undertaker (Name) I' ter (Address)
the to hold tempora ' the body.
p g corpse) , emove, ise dispose of [state how])
([Inder er or ern haying�E�ar a of cot se
Dated 1uOV• x �yy ``jj 19 (Signed). ....,
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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