Lee, H Frank NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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.
Dn. No..,.. 5601 Registered No...._313. '
Town
County Warren 'illage.._._._22....Cx:andall--St. Glenn Pally ii.. Y.
or City (If city. give street address)
Nameof deceased....__._.__H. Frank _j,,Qe_._._......._...._.._..._................_.__...._.._............_._._._....__........_......_...._.__..
Male whi to Single, married, widowed, yP1dOL79d iv0 V. 7 Sex...__.____Color Or divorced (write the word)..............._.........e......._._._._._....Date of Death....._._..._ _...._.....2._.__._.19._._s't.7
Age...._.._72._._..Years.._._._..._9._...._.._.Months..._.._._27_._.._..Days Birthplace.. Gzr.earild.Gh,.._'. .__Y.....__. -.
Cause of Death.._._Carcinoma of Prostate-6 .yrs. ...............__.._...._..._._ __....__....__..
Certificate was signed by_.__Dr._..H.r._.A_...... .aril?.9...1.om13.Y[..._...._._._.............._._._.......__._._............_._._..._._._....._.............._...__._._...._._.._.hf D
Address....._.__.._...._._._...........__.._...._._. 018.nS....Fall13e.....N......Y.___._._..._._.___._._.__._...._....._._.._................._.__....-...._....__......_.._..._....__..
Place of Burial (or Removal)..; @.Stt.._..Glans....Fal13.r._.1d..._.1rw.--.------.--._ .-._...._._.
(If body is to be tanpor.nly held. fill in spate larr .......—_..........._._._...._...._.._.___.__._..._ _._
Cemetery._.___f,...A.IrDhQfa.u.S.__Q.eeie_t.ery. Date of Burial Nov, 93_.
(If body _.........._....._._........_._._.__._. ice 'y?P.f_._._.___._.._._._.—
is to be temporarily held. 6I1 in space later)
_...
The Certificate of Death containing the above stated particulars, having been presented to me, after careful examina-
tion, the sante 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..._.._....... .James F r_.__S nBlQto,[)...._ Glens....Falls)....N.,.._`try..._...._............_._.
.....
_ (Name) (Address)
the. Undertaker
to hold temper. G' • . ra r the body.
comae)
(Undertaker or person having charge of co nun. or otherwise Isun boll)..
l
Dated..__.._....._....iiAlt.._.19., 19.32.. (Signe( )......._
Lot,' Regimen
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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