Flanders, Tryus NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT 3
i
Mir 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 WRITTEN IN DURABLE BLACK INK.
Dish No. 5 601 Registered No.. .1.4.8
Town
County tla.imeft Village Glens Fa,ll,s Hospital
or City (If city, give street address)
Name of deceased Tryus Flanders
male white Single, married, widowed, married 16 37
Sex Color or divorced (write the word) Date of Death 2 19
Age 80 Years 7 Months 21 Days Birthplace Hadley, N. Y.
Cause of Death Exhaustion & shock following amputation of leg for senile gangrene
Certificate was signed by Dr• 8a B. Probasco-. M.D
Address Glens Walls, N. X.
Place of Burial (or Removal) West Glens Fal ,, ., !L....,,X.
(If body is to be temporarilyheld, fill ins ace later)
Cemetery Mt• ermon Cemetery Date of Burial May 18, 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 Clarence Rozelle Hadley, N. Y.
(Name) (Address)
the Under..ttaker to hold temporar. .. .. ..r the body.
(Undertaker or person having charge of corpse) ( nt , ove, or o i dispose of [state how))
Dated May 17_, 19..37.... (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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