Joubert Sr, Joseph torte ra. Os. e.14ra.,u.vov rt/-rn 3
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Sr 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.......... __ . _ .. Registered No 62
Town
County.Warr ea I_s1..Ut.. .X _
or City (If city, give street address)
Natneof deceased._._..._....._._Joseph Joubertx_Sr_ _._...._...__..._...._.__._._._._.__._._....
Single, married, widowed,
Sex._ $1.8_.Color_ divorced (write the word).._,widowed. _._.__._.Date of Death....._..iilarch4, _19.._37
90__�_Yearn.__ 2._._...._.._.Months..._.....0.9 Days Birthplace.beC.Y..I.).� e..ap-.a.SZ�_}Srs13ad.&
Cause of Death.__._.G*elppex acute._,Nephritis;Terminal.....pneumonia._...._._..,..,,,__.-._..._..__...._.....___.___.__—.___
Certificate was signed by... _..._..__ —_..._._._I<f.D.
Address..._.__...._._._._.._._._._._._.Glens..._Falls,._._rI•_._Y._......._......_...._._._...._...._.........._._............_._..........._._...__._...._....__.__..__._._...._._.__..._
Placeof Burial (or Removal)..........._._............._._.............._ _...._...._..._.__........._.......__...._._._._....__.__.__._...._._......_......._...._...._...._._...._...._...._...._...._._.._
(If body is to be temporarily held. fill in space later)
_Date of Burial._ LL�1^Ch.... ...8�......_...._.__I9. _
(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....._...._....1 i.onel .tla.....B.o..iu.i.n.. __... G. ns....Fins,._._I .a.._X.e._._.......__..____._...._._.__.--
(Nsme) (Address)
the_.__._......_.._Und.ar.taker to hold tempera .. �ri.t.e.r........._.. .......__...._....__._..._._...._ _the body.
(Undertaker or person having charge of corpse) r move .se d.spes. of Rest. how))
Dat••d___hibLCA.h 5.,.. 19_32. (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 remora( is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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