Hay, Audrey NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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 Or
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No 560.1
Town
County.._._..__....._......._._,_arren..._.........._._....._._....... ................_..................._._..Village_.._Glens_F.fL.18_..ILQ.,9.Pi..t.&1
or City Off city. sin street address) __•--_.._�...
Nameof deceased___.._...._._._Aud Ails._Men_H }L-......._._._..._....._...._.__._.__........_.__...._.._._..__.__.---._._ ___......_........_._.__._._...._...........
Feroal 51h1te Single. married, widowed, Sin ale sexBColor__........_.-_.__or divorced (write the word)...__......_E'i._._._.._._.._...._ Date of Death...___..._._....DeC 8 37
Age.._..r..�..-=__Years.._-_-..-..-.C_.....\btnths.........._._...._._.._Days
Cause of Death...._...._.._uongen.i..tra1....Heart
_.._._....._._.............._......._...._._.._....._.__.._......._._.. ..._...._...._._._.... -- — —
Certificate was signed by_.._...._..__......Dr,.....,Jm..._.11.....P.orz.eTL_.._...._..____._._.__.._._._ ___...._..._...._.._._.__._....- _--•---._._._._.h1.0
Address._._.__._........_..__.....__..__._........_Glens.--Falls, U. y„
Place of Burial (or Removal) Queensburyt lL.-..Y.e.
(If body is ro be temporarily held. fill in space laver)
Cemr
Ill bo y so temporarily
.rile III in isie..t9i Jl....�1H111.t._....__.._.__ Date of Burial D.L'G.. . ._..1937.._....._._.__19.._._.._
Itf b<dv is to be held. fill in space burl
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 SATISF.\('T( 1RV AS REQUIRED BY LA\\.
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__......_._...__...__Harold C._-_Stafford......_..........._........_.__..._ Glens Faller F. I.,
Name) IAddreul
he Undertaker hold tempnrr a e in vaul _.__._._._........ .._the body.
(Undertaker or person harms charge of w rpael � �L. o.�e, or ElRlrwtw� seof Inns howl)
Dated...__. Dec , 2 .4__........_._......._19..37 (Signed t. .. ..._...._........_......._._.
Local Retasaar
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 remold is by common carrier. in which case a Transit Permit IVS No. 62) is required.
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