Weaver, Jay [UrILI so. US. O•LV•)1.1V,VVV t1/•1 YL?)
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 !7 3
tarren V218 Glen Town I n Street
County Villageree t
or City (If city, give street address)
Name of deceased Jay Leslie Weaver
Single, married, widowed,
Sex M Color White or divorced (write the word)...MMarr.i..e.6' Date of Death April 2 19...,'2.2.
Age......... Years 6 Months 24 Days Birthplace Athol , is:. Y.
Cause of Death Cerebral hemorrhage x valvular heart disease
Certificate was signed by.... Dr. Floyd Palmer M.D.
Address Glens Falls , N,Y.
Place of Burial (or Removal) Town of Queensbp,ry
(If body is to be temporarily held, fill in space later)
Cemetery Pineview Date of Burial April 4 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 , N.Y.
(Name) (Address)
the Undertaker to hold temporari nd Inter the body.
(Undertaker or person having charge of corpse) ter, rem e, o -orberwise dis of [state h j)
Dated April 3 , 1937 19 (Signed) / Y
eputy 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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