Mickel, Myrtle NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
wir 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. 53
Town
County Warren - ‘"illage42 First St "Glens Falls, N. Y.
or City (If city. give street address)
Name of deceased Myrtle Gunnison Mickel
Single, married, widowed
selemale Color white or divorced (write the word) widowed Date of Death Feb, 6, 193a.
Age 77 years 5 \ltmths 24 Days Birthplace 6tym Ackworth, N. H.
Cause of Death.Art.e.ri.A-scl_er..osi.s-9 Mos.....19....days.
Certificate was signed by Dr.. Henry E. Clarke M.D
Address Glens Y.
• Place of Burial (or Removal) Queensbury., No X.
(If body is to be temporarily held, fill in space later)
Cemetery G.u.r ey Lane Cemetery Date of Burial Feb. 9.,.
(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 SATISFAt.'TORV 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
perry 7IQodward Warrensburg,. Ni 1.4
(Name) (Address)
Undertaker to hold tempora r the body.
(Undertaker or person having charge of corpse) (It ove, o se dispose of [state bowl)
Dated Fe.b... ....9., 19.3.8 19 - (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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