Gonyea, Gladys Form vs.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CERT ffeTE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. ��Regist r No.
Dist. No 5601 County Warren ;`�' ���
or City (If city,give street address)
Name of deceased Mrs. Gladys Gonyea
Femal White or
married, widowed, Married Au List 15 19 38
Sex color or divorced (write the word) Date of Bath ...1..
Age 20 Years 5 Months 24 Days Birthplace lens a11s i .' .
Cause of Death Sjiogk from 2d degree body burns
Certificate was signed by...E.B.Probas00 M.D.
Address Glens 'a WY.
Y.
Place of Burial (or Removal) West Glens Falls 'Cemetery ,West Glens Falls t T.Y.
(If body is to be temporarily-held. 'n r)
Cemetery elnsTansCemeter Date of BurialAugust 17, 1938
(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 a n the basis thereof I HEREBY GRANT A PERMIT
to oisv ` e W. Collins 16 Main St. ,, So Glens Falls, N.Y.
Orville W. Cbtttns Inter (Address)
the to hold tempor the body.
( dertaker or on baying char corpse) r,remove, se dispose of[state bow])
Dated AUgUSt i�l' 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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