Dorey, Armedos Form VS.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ltar 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 CERTIFICA OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No......Z.Z...L...........
Town
Dist. No. .N I, County liltarX011 Village 47.... Ati.c AX1.., t,..,G3.enS. .T+'i ills., .111».. v
or City (If city,give street address)
Name of deceased Armedos Dorey
Single, married, widowed,
sex 1.Ia1e Color White or divorced (write the word).M.U.21e.d. Date of Death Apri.i..2A.1. 19....38
Age 58 Years Q Months 22 Days Birthplace ranada.
Cause of DeathAsrharxiation from 1l1uminat ;> g,,,ge.g, ,X.e r .lni.nu.t s. (211.i.c...ds.1.)
Certificate was signed by Dr. H. A, B rtholomew(noroner) M.D
Address Glens Fal is N. Y.
Place of Burial (or Removal) T459X1...Oi'...Q,??..e11.�3t11Ty.... Y.
(If body is to be tempor r.ly held,till in space later)
Cemetery St- Al nho n su s C em etq ry Date of Burial A .i..]....23., 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 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 Harold Q. .tfl#'fsd Glens Falls, N. Y.
Undertake (Name) (Address)
the 1' to hold tempura ' I n tim the body.
(Undertaker or person having charge of corpse) r,remove or othe se dispose of[state how])
Dated Anria...21.. 19....38 (Signed
ocal egistrar
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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