Gilbert, Nora Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rir 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. 57
Ts m
Dist. No...r5.7.2.Q....County WaSk1. Jgt.Q.f Village Hudson...Fal1,5.,....ii...X.
' (If city,give street address)
Name of deceased Nora Hoplans...C. Ubert
Single, married, widowed,
Sex..Fen.a.Lrolorr .t.4....or divorced (write the word) i arri0- Date of Death....5ept.t~m1).er16..193.8...
Age 7Q Years Q Months 16 Days Birthplace FQx..t...Ar�n,,...N...X..
Cause of Death Chr. Nephritis — Chr.� Myocarditis
Certificate was signed by J, Leonard Byrnes M.D.
Address Hudson Falls; N.Y.
Place of Burial (or Removal) Queensbury, Warren CouBty.,..,,u?,,.x,
(If body le to be temporarily held,fill In s ace later)
Cemetery pest Glens Falls Cemetery Date of Burial..5Q.Rt.QR?)? r 21. 19.....
(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 he 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 Will Carleton Hudson +'al.lrc,.,.. N„X.a
the Undertaker (Name) I t, (Address)
to hold temporaril and n r the body.
(Undertaker or person having charge of corpse) (Inter,A,emove,or otherwise die/� Dose [state howl)
Dated $eF.t.Q:Ak2Q.1;' 2.Q.,.....19.36... (Signed)... �r.
L Local Registrar
This Permit is su`r-ient for the Removal (and Interment or Cremation) f a body
to any part of the State (subject to local
cemetery or other rein. :ions), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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