Belisle, Aurelia roan v9. 01.
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...,55.60.1 Registered No. 1.61
Town
County Warren Village $ Big. CrQsQ....St,,.Glens Falls, N,71.7.
or City (If city, give street address)
Name of deceased Aurelio, Belisle
Single, married, widowed,
Sex f emalQ;olor whiteor divorced (write the word)widowed Date of Death May 20, 1937
Age11 Days BirthplaceGlens Fad.. ,.s.., N. tr
7� Years 6 Months �ti..� .� .
J.
Cause of Death C.o.r.ona.ry 0.e.el.us.i.on. —ar._ter..i.o.s.—sclerosis years
Certificate was signed by Virgil I?.. , .e.i.1.e.k., Ne.al.th 0.U.f.i..e.e.r M.D
Address Glens Fella, N. X,
Place of Burial (or Removal) West Glens Falls,,, N. Y.
(If body is to be temporarily held, fill in space later)
Cemetery St. A.1.ph.o.r;).auz t C..P...n.et.;w ' ' Date of Burial May 24.., 19 3.7
(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 Seward T. Potter Glens Falls, N. Y.
Undertaker (Name) (Address)
er
the to hold tempora d. .. t the body.
(Undertaker or person having charge of corpse) Weer, e, or otherwi a of [state how])
Dated May 24., 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 regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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