Dantz, Fred NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Onr"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 357
Warren - Town
CountyVillage. 55 Sberman Avenue
or City (If city, give street address)
Name of deceased Fred W. Dantz
Single, married, widowed,
Sex. M Color Wh or divorced (write the word) Single Date of Death Dec 29 19 37
Age 09 Years 9 -Months 10 Days Birthplace
Luzerne NY
Cause of Death Cerebral hemorrhage
Dr V D Selleck, Health Officer
Certificate was signed by M.D
Address
Glens Falls
Place of Burial (or Removal) West Glens Falls, Town_of Que.enzbury NY
(If body is to be twegitlY tli6fLfig] spicattn
Cemetery Date of Burial Dec. ..3.1 19_31.
(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-
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 Rogers & Carleton Hudson Falls '
Undertak —e Inter (Address)
the to hold temporarily (I the body.
_
(Undertaker or nerson having charge of ccir,R4) 1,:er remo e, or(if rwis of [state owl)
Dated Dec 30 19 °7 (Signed) ., 0',_ . _
Depu y 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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