Gifford, Robert NEW YORK STATE DEPARTMENT OF HEALTH �.
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Dir 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 CERTIFICAi'L OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No. 5601 Registered No 232
Warren Town 60 Hudson Ave . ,Glens Falls ,
County Village :.
or City (If thy, give street address)
Name of deceased Robert Gifford
Single, married, widowed,Sex male Date of Death August 13 1937
Color Jh z t,e or divorced (write the word) single n ;l e
Age —x,---- Years Months 1 hr. Days Birthplace Glens Falls, N. _ .
Cause of Death a r.e.ima..tuC.,....B ,r t,h
Certificate was signed by Annie Null M.D.
Address G1..ens Falls., N. Y..a
Place of Burial (or Removal) clueenbbury., Warren Co .j N. Y.
(If body is to be temporarily held, fill in spacelater)
Cemetery • rrarmon emetery Date of Burial Aug. lo, 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 .<. C. 17ilson Hudson Falls, L.T. Y.
(Name) (Address)
the t.I.nd.aX'.t. .ks,. . ' to hold temporal' er the body.
(Undertaker or person having charge of cor se) r ove e Ise dispose of [state how])
Dated . a LLlst 14 , 19 31 (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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