West, Harriet rorm Y . ul. O.1O07.7u,UVu (1/-114,)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
DIP 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 5.6.01 Registered No....3.6
Town
County Warren Village Glens Falls,N.Y. 67 RidCe St/
or City (If city, give street address)
Name of deceased Mrs . 1-Harriet Be West
Single, married, widowed,
SeF'emale Color White or divorced (write the word) widowed Date of Death Feb . 6, 19 37
Age 8.6 Years .2 Months 2 Days Birthplace...NQ.17:thV.1.1.1 e.,.....I.I.*..._X..*
Cause of Death Car..c.i.n.a.ma....a.f Uie ao.lnn.76. .mas—
Certificate was signed by...Dr e I..1, L, Na v i l and M.D.
Address Glens Falls , N. Y.
Place of Burial (or Removal) Town of q ,pensburJ, r;al^.i,;.e.x o , a a e
(If body is to be temporarily held, fill in space later)
Cemetery E.i ne Vial( G.eme..t..e.xy Date of Burial Feb... 8., 19... 7
(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 Ca Stafford Glens Falls, N. y.
(Name) (Address)
the Unded .a, .r to hold tempos .tar the body.
(Undertaker or person having charge of cor se) emove, or dispose of i state how J)
Datrd Feb . 6..s. 1937 (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 removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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