Jones, Baby boy NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
DC 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. :1°
Town
County Warren Village. Glens Falls liQapital
or City (If city. my, aunt addreml
Name of deceased Baby bsy Jones
, . Single, married, widowed,
Sex...—.1.AliqColor....V.B.Eta.or divorced (write the word yflill.Plati__Date of Death.. sally.w.2.5........1.9..a7
St 111/biirth Gle
Age... ea S Months _Days Birthplace ns Falls,. 1.r. Y.
Aut ace ident
Cause of Death o
Certificate was signed by Dr, Paull Palmer — m D
Address Glens ails, N. Y.
Place of Burial (or RemovaDT.0)Y12 Of Que.ensb.uty..,__Eine 1Ziazt Camatary..„—N. 4,--
Ill body is to be temporarily held. fill in space later)
Celllettry---...Ling....11.0.37 Qaux.e.tar . .Date of Burial._ July 27_,_. _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 he 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
Joseph F. Regan Glens Y
la
(Nhm) (Addrws)
the Undo r taker _to hold temporari V Int er .the body.
(Undertaker or person haring charge of c . remove, or oth im dispose of (state howl)
-/ated.. . Ju 1,y , 19 01 (Signed .
Local Refit
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemetery
_.40000,001
%er regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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