Bennett, Fred NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
go-This Permit can be signed only by the Local Registrar (Deputy or Subregistrar) of the Primary Registration District (Toler
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE Oi'
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No...5.601 Registered No 2
Town
_;ottnty Warren Village Glens Falls HQ.s.pJ.. t.al
or City (If city. give street address)
Name of deceased Fr.e.d..,.8e.1]X1e.t.t
h�4a1 e Single, married, widowed,
Sex Color white or divorced (write the word) WldOWOd Date of Death Jan 1, 19 38
Age 55 Years 6 Months 29 Days Birthplace JohnsbVlrC., N,t Y..,
Cause of Death Chronic Uyocarditis 6 Mo .-cirrbosis of liver-6 Mos.
Certificate was signed by James a. Shields , _ M.D
Address Glen$ Falls, I , I.
Place of Burial (or Removal) ZIAp e.i$t?Ar N.. Y...
(If body is to be temporarily held, fill in space later)
Cemetery Gulrney Lane Cemetery Date of Burial Jan t la 4., 19 38
(If body is to be temporarily held. fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful examina-
tion, the same appearing to be COMPLETE, CORRECT, ANI) SATISFACTORY AS REQUIRED BY LAW.
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered Number,
and on the basis thereof I HEREBY GRANT A PERMIT
Neil D... Tripp Lake George, .1`I... Y..
(Name) (Address)
U de.r.t.ak.er to hold temporal:: 1 t..e.r the body.
(Undertaker or person having charge of corpse) n�mo:e, r dispose of [state how])
' a::.l Jan 3, 19 3$ (Signed)., ...
----
LA cal Registrar ti
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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