Prouty, Ellen 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. 5 601 Registered No. 22.9
Town
County Warren Village 23 Haviland Ave .,Glens Falls,N.Y
or City (If city, give street address)
Name of deceased Ellen Prouty
Single, married, widowed,
SexFemale Color white or divorced (write the word) married Date of Death AU,ust 101 19 37
Age 85 Years 2 Months 2 Days Birthplace Vermont
Cause of Death Arteriosclerosis-1 yr. :cerebral Hemorrhage-7 days
Certificate was signed by Dr, Dwight M. Sawyer M.D.
Address Glens Falls, iv e Y,
Place of Burial (or Removal) Town of Qi eensbury,,
(If body is to be temporarily held, fill in space later)
Cemetery ,.18.a.t G;.e.13$ Falls 0.e.m.eIery Date of Burial A.ug.......1.21 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 he 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 Joseph F. Regan Glens Falls,. 17. Y.
(Name) (Address)
the Undertaker to hold temporar' , .t.e.r the body.
(Undertaker or person having charge of corpse) In er ove, or ise ose of [state how])
Dated Aug., 12, 19 37 (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 reguiations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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