Green, Marie 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?2
Town
County Warren Village2 Park....P.la.c.e..,.G.1sns....F.al1B.., L. T,...
or City (If city, give street address)
Name of deceased 1Iar7 e Lot isQ Groen
FBmale_. ,rhi to Single, married, widowed,
Sex Color or divorced (write the word) married Date of Death Aug. 4� 19 37
Age 59 Years 3 Months 1 Days Birthplace.. .ghi,fld., N. Y.
Cause of Death artero—ge1eX.oai.L-5 y'..r.a... c.e.r.e.oral....h.emo.r..rhaga.-1.o....mo.s.
Certificate was signed by Dr,, Edsal l D, B , &.1.1 .o t.t, M.D
Address Glens Falls, N. Y.
Place of Burial (or Removal) Town of Queensbury.1 N. Y.
(II body is to be temporarily held, fill in space later)
Cemetery Pine View Cemetery Date of Burial Aug 7,. 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 Fall. ., N. Y.,
T (Name)
the I nd. r baker to hold tempor -per (Address) the body.
(Undertaker or person having charge of corpse) - esr [state how])
Dated AMOLit 6..,. 19. .7.... (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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