Suprenant, George rurm Y . 01. o-io-»-)u,uuv
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
our 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. 5.6.0.1 Registered No.
County Warren T liage wn 13 Dix Ave. ,Glens Falls , N.Y.
or City (If city, give street address)
Name of deceased Ge..oxg.e L......_541...reriera
Single, married, widowed,
Sex Male Color Whiteor divorced (write the word) nte.r. '.i.ed Date of Death Ja tua}^y 1.,...19..3.7...
Age 68 Years 5 Months 28 Days Birthplace 'z...e.ne.....Fa1.1S..,... Y...
Cause of Death Carcinoma Liver--1 year
Certificate was signed by Dr,.,...n,,..._.tj,,....S.i,.ng.],.e..t.Q.n • M.D.
Address Glens Falls , 11, L..
Place of Burial (or Removal) W.e.s.t Glens Fa1.1e.,....iL. Y...
(If body is to be temporarily held, fill in space later)
Cemetery St* AiPhori$t,W CeIIie.t..ery Date of Burial .Jan.. 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 J.. m8 F..,......Sj.nL.l,eton Glens Falls, N. Y.
(Name) (Address)
the Undertaker to hold temporl er the body.
(Undertaker or person_having charge of se) (I , move, or otherw' dispose of [state how))
cor
...... . ...... '. t
Dated Jan. 4, # 193 (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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