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Ricketts, George Form VS.6L 10-21-37-25,000(17-3459) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT mr 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. Registered No. .._? _ 56©1W n Town County33 Sheridan St l, s Y Dist. No ar�Pr Village e aG �l� �:��..j.Q.,...�.. Name of deceased or City (If city,give street address) George H. Ricketts R Single, married, widowed, Sex... 'lal.e....Color.Whit.e...or divorced (write the word)....mar.ri.ed Date of Death QC.to.b.er...89.19.38.. Age 63 Years 1 Months 21 Days Birthplace....Phi,i.ad 2.11h1.8..,...Fa.. Cause of Death C o 'ofl, y TLX.Q1 bQ. j,s — • 'Qw Mj, u PP Certificate was signed by P.r, Vixzil... .w...$g. .1,QCX.,...11.eal.tch...Q.ffiC.ar M.D. Address nen§...Falig.t. a Place of Burial (or Removal) Town or Queensbury, /I, Y! (I boe to be temGurney Lafill nesce later) 1 , 1938 Cemetery Gurney Y Date of Burial Nov,t (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 exami- nation, 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 reward T. Potter Glens Falls, 7 . Y Undertaker (Name) (Address) the to hold temporari d. .ti the body. (UndertrtaVker or person having charge grime) ve,or oth spose of[state how]) Dated IN ; 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. rH0 a 5,,,:) ,, . o go ma, 0 •..-' (n c n o•c o o g n r ow •, a o ' u, to m e e, c r a,B »,...�ae 0. n0•nn cnn ocs .. ., a < Gp•,3 y a �� O o m gnno•o.an+ dNc 8 ...o nw » . w a''•^� nW' ndv.a n' Cf oona yn 9y M Wnn3N =O on O < » ma8n3 , O nna CD C� L��nna ww , awayem� ° � ca,e • ^+ � � ao � Cnc � �� .! °0mpa ,Z ; a ro a n a ro ann � � ,0 -,- co cm n cn% �.ti m �"l� =° 5nn � n a. _ � : �b cr oMW^ � ' ' � �� fo 'wna � v � 0 xne . ^' Zmtyy < x< e ,DnO -ny pra'aocc .inM - caa oa - p° 5. n fri y n ::w m O t w O 'co-,. �• n n nwita"t°"a'^..-.••a 0 C•n O O wn nw Aan P.' cn p+0 ^ v .1m >C :4' na � . o ., wap � y onm • nc . 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