Rollo, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
air 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 323
Town
County '"!arr...en Village Gl....n..s Falls Hospital
or City (If city, give street address)
Name of deceased Joseph Rollo
tY2ale Whhite Single, married, widowed, single
Sex Color or divorced (write the word) Date of Death Nov. 25, 19 37
Age Years —Months 5 Min.—n si Birthplace Glens Falls, N. Y.
Cause of Death I:iio.r..o.o.e.phalus.-.1 dy.s.....: i:eni.ngo.G..el.e-l.d;..sa
Certificate was signed by Dr. B , C, Tillotson M.D
Addres Ft . Edward, N. Y.
Place of Burial (or Removal) 71. G. Falls, N. Y.
(If body is to be temporarily held, fill in space later)
Cemetery $t , Alphonsus Cemetery Date of Burial Nov. 26? 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 SA'h1S1'ACIORY AS REQUIRED BY LAW,
T 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 Lionel J. ''oivin Glens Falls, N. Y.
(Name) (Address)
the Grns er to er to hold tempor, ' :l er the body.
(Undertaker or person having charge of corpse) r , o-e, or othe i ispose of [state how))
,'a'.i:i NQV. 25., 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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