Newkirk, Matilda 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... /6,
Town
County 'larr.e.n. Village 2 Hoyt Ave,l,,,Glens Falls, N. Y.
or City t If city, give street address)
Name of deceased 1184
Single, married, widowed,
Sep ellale ColorWhlte or divorced (write the word) married Date of Death Sett. 3 _ 19 37
Age 47 Years 3 Months 13 Days Birthplace Jersey City,,. New Jersy
Cause of Death Carcinoma of breast-1 yr 9 mos.
Certificate was signed by Dr. James , Shields M.D.
Address Glens Falls, T. Y.
Place of Burial (or Removal) Tgwn of i ee1:i bury..,. N.e.w York
(If body is to be e¢tporarilvheld, fill in ace later)
Cemetery rine View Cemetery Date of Burial Sept. 5, 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 Harold C. Stafford Glens Falls, H. Y.
(Name) (Address)
the Un ,Q.r.tske.r to hold tem • e.r the body.
(Undertaker or person having charge of corpse) em
Dated Se;7)t ♦ '�T, 19..3.7 (Signe a dispose of [state how])
I..oca egistrar
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.
�• y SG '� O Tw O +.c`+ �.O O 'GN bb •n bb Nb b $ y o $ $ •..,< o t Ir.5-$ oV V).-. .
J...- -•Z" •'-= 0 n n 7 xn y ry 7 y 0 0 ii y S 7 T 7' -nt y C A�7 0 ni N O A•n'1 -`1-n .C..i 7'C •y ... ,7..�. ...R 1.-1V 7 .0 V7 d
" ., .w.0. �. `< G C n n 'o N co F y N i'-y n 3 ' 7.n 7 p CI O a n A t m
'..:�? •y `� 0.Ty 7"ry A 7.�rny9�3- C-i• n' yco,AA, 7 ry O C O _7.�t0'' •.t 7 C.a •n t°, C'Sn • "' O�7 c Aco �Oj 7i rf co m O A t1
7i T• � `` ww O b »nC3 � '� .w.0.C. 7n W^O �' wreC wn .� wt�D ° 0. W n ^ 7 L °
Q.
I= ^G?.cy 3b 0.3 W-, -C.rt c -woo -< 7.O V� < 0.w SS-0 3 ,1 ..'y 30 y.. rt V y�o t: �, .., r
.....w v ^- w N w y.< .w.0)n •b $ 0 0-- O �Ow � C n n Z�' .0 •0.w M w•7•boKo v
A .. > 0 ' - 0 -•n **a 10.< O•. n ....
-G••• IOi, • °., ° n m=S n 0 7'fe '' rt. n. n•1 .c A.
^ ° .-..r+ 17.n n es(I)
R7 S- Sn -•Q 7 C. °CP "-•►ate i1Efl1!:! !
oO O n7Fij
7n yn0onns wn. bsw0 ° '0..aS� -oaoo ys"� . ow nArri E7n're cp_ _�-n -1 m ts+N G. •c v z•_- i), �.7 7 n h X S y O- '0 2e o p n y N yw < aC .�( .13`< 7'`7pNo - -c C � SJ:N .N o• yN .
; 3•3 -1 .. .. n yp�KnnC. =e7yn NC n 3 N a c _ 7 n .. 7 •w 7 `�
w n m N s. N w n p .o �'�- n sp ° n p - , w a^n cr. n fy A Q K]1D
F . .. y OQ co p n O N'O f 9 n w w`< c^F '^?• 'n3••n *C,1 W 7 ?•n p ry'' 7 °b •n`< '+ < .. P G F-1
4! i^ w n 7-,,, n w N O dN 7 _ w * , 0. -." _ y n v, y w 7 Q.n re R1 a °-a
. �_..b o-p• '' .O.-r, n z n ° c, G 'O n ee *,-; 7, w : g "1 -+n % GN•CH Artll° ..
n Nns. 3- n0n 'S'-' c-c� - nc o < y Ay •=„ wr' M Nw -.41,,pQ ",. . _v '` ''.Tg `en * = 3 'na.onc}og .-.- � 0;.'"0 etr1Z =a XI
�s'� 7:: �0 N c-7'C•° $ ^- c„'n H �.;. m n y n a° L' - -W3n -CO -I w n 0 .0 oar H o g Ci7
� x 3na, na yYb `c.n+ �k n _ r Non0� troll (bow -0� c�379o�ycooq1 `° �" �o ' p
�'Z0
b=• __ _.n N < w.i7e•R O T n w 'y' o -."°0, _z C n w y y .p 5. n ^ = w t., 7). , y O p M R %o- D 1p� Zr
`� w Q: n w 0. 7 y G 7 Fe n -'c a n o •C n n n -•- - .N. �' n•7 y eo H w ..° z• �+"g'' w , -•Y p O• .7 7 y ° n s w ti - .� ? a: . •-e T' - ._. .•1 7- ..0 w A ati C7Q''- _ y ° -QQ �p•°- y �'c � G.wc� � °,•_< •��'�;- ,., v_ °� f.- ^.Nb �'w �+- � c � n-H A `O9 ��
'..i7=_c ? wb c A brs - n c• C1.7 w A
7 '77 tt7" - :.y v. a 7 y w N O'c< n O ru w •1 n:R.y n n C- ..:P> �;•�•G^w y fD n ° < n y A ^I
rr J7.rf,..,.2 S y H °,..__42 2..7'--•° w C. Z .1 ;w p;w Y O �.O N = = -1 y n n. -- 1 O ~ r)i
': }7i--10,. -- ;.5 n n N w -yrs.-y C.-••O e; n n n 1,.t9--vr o-f. " •- ; c _ =' .7 c`Cy 0-y < .. a IA-f)
,< - G--..._re 3y• n7 "^..f ^ F n^nioo' C:u' Sti ;.r. = tea' Egii) "'l'. 1-�+
i-i w) . ' 7'3'n _ ° y v r°:6. A.' g a J -....n a n-. -. '' 'r n 5 ►3 „ `m' 1 rlr
• wwyoycc 'G c,° y n < ie _ NO7 ..n w o
3 `0 "' - n V' 0 3 3 n'o y ?z f cD n ? b 0•`t N w w y n "t c .�n' r'T• d•y Q- -7--• 7
O m _ r =-'O o ow ° yp=3cE' 2 � nI. 02f �,- �~ .-A: .< o" 3 ° m �'ee770. 9 �.-yr
' � J NSn.C.rD 7'" 7- n �' 7 .7. X3 C $ w "won 3w n ^0o n w ;' n72h
o �Ya c .w o 0 7 re? 3• - - '_.= 7-_ s� _ n y ° cA-Vi ...el t
n _ 0.3 �'7 •.» 'S S++ n 7 � a'-r'b O Cr ""fin »c n .�••
O [-1/7 xtlq 1' SW � O G..w y n 5• O S n -. CJ•R C ., n ^ni n ,'-, a G m' ni n n n w w pp 1"-� A R y 3 I. g 7
2 Z .n -..< 7 ¢.n 0-1 n ty'-n� O < w 0-co g N O -, -n � W n ^ -..•^,� w � 0..< �.7'p 6- - 00 m G
L)-17 7'n b 7 • N w N'w .° y^. 0-re <`G S 7-O k ' tv('')wtygj !EI
n - ° R iIil
y la cS - -n+ �?n t�l3� wA 10 V. �Z I.
o U .O y _ •.-,.n C 3:" 7 n• n _.cr o- 3 A> =bn y 61 ^N O y O o o cr 2 3 C;w =" m ),,,]r
_ - nv 3 ° N nNnn f3p •� 7C' W atoyp .n O '� yacc "V..•7�,0�.1 7j
A _ ? w n r co " N L �ati.F :?w �.o.j yva y et n QQ .< `� y d 1!.y.V
c r3_ ^ r - N R C R ci, n y .Q 7 n � .N-•O Z C‹.A � 3'N. J� 3 3 = y n r: g•�Q7 rrt,k< • C.,,, 0.c V w 6.
7 < -CG-030 nm,-.., n _ wpm n .33wy w '3 ° N n
R - 9 n ".0 -1 0• 7 -,.n w-1 cxe *w ?;o- y .....4 w•b to) OQ e, n y `e 0. y 7 et,
y,<co r •• n
p 54., n y 0.'d w n .+w y C-0'a.'y 7 n n a•7'w•--•• y n w p'7'_.,. o_ "S ° 5•p.OQ n > CA w I .\
O r(AO 3•y n w ni -ni 7 p.n N: n T OR do n nb O C p•-^ n c<e e7n ° Scye y n O ...° 7•c rJ.HE
w... n R.3 n A W O _0 ° ° - -,- 21 -, -.= p 0 O n n d o '� .+.nl 3.O y n vwi O-`n w OR.9--t y..C ".N ""4 F•ee ›.. f�
�zA n ^ n 7C'7 "-r H -.. b y ^n 0 0 N y N r•r. ° D,n C N N n n w-..0 Sw •-•'t. xT C
mQ c w3cn- nrin •oog' in. .-• Sb'77V=o po9 < S . y» 0 -+cW• a• wo o ��' C
A 'A ry w 7'�n = -1 b b A p.7 n,I N C n p 3.3 n N N p '..w n C ro p ,....0 n S y n n w p ,N•�0 .1 y =� .A y A
.1 �j1 '< re,' y (e ...-,it b < n n n=e 7 0. A. 7 .., n w 0.n y -c n n mN �.j�11EA t
~
•
`^rl :n t� nRi y A n M ° y .p ° ° n �K b 7• '< �' f9 TN C. N ° -e w 3 C3 7 N ii.�rl�1 I!
Qa � Cy < y� n '3r.�. 3'a � o .», yy Ngs� oa�� wN . °Y, M^ -,,,_ � m < v, r. C<
q'b0 -•a. •o a 5_'o n y 51'Mw o SSW ...p 0 ° _.n 0 '"-„,'n'° u71 0 o p 0n ° ° f-_.w o _to n c° °y° o 0-1 .
.� S v.---, ••1 -.-.•..N n. co P..N et n Co N y •J v. 0 ...CO ..OL 1 .•h a'-7 -'! n M 3 `co y.. 1 d n .7 ly o ff