Traner, Isiah torm Va. 01. O-10-3)-)1.1,VUU (1/-1'W)
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. J C, 1 Registered No....1Z
Town
County Warren Village 3. E1m...8.t.re.e..t
or City (If city, give street address)
Name of deceased Isiah TrEkAta
Single, married, widowed,
Sex .ili Color Yhit..e..or divorced (write the word) Divorced Date of Death January 8 19 37
Age 70 Years 0 Months 5 Days Birthplace Gl.e.ns....Fall.s., i:.. Y...
Cause of Death. L . a neumo.n.ia.; di b. . i.s e.11i.tus..; ch-r myocard.iti.s.; card.i.au.._.dee.om-
pensa •ion i 'ert elbow
Certificate was signed by .T•w..'•ile•S•..•B•.•••• hie .as M.D.
Address Gl ens Fa ,•l....,.,..,.* Y.-
Place of Burial (or Removal) West Glens,F+.,all$..,....N...Y..
(If body is to be temporarily held, fill in space later)
Cemetery vle,s$ Gle.n.a..1..ails Date of Burial January 10 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 Lionel J. Boivin Glens Fal1.5..,....N....Y
(Name) (Address)
the Undertaker to hold temporari • Id I. ,t.e.r the body.
(Undertaker or person having charge of corpse) er emov , or zrtise disp ate howl)
Dated January 9 19....3.7 (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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