Grundy, Tuffied Form VS.Si. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t2r 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 CERTIFLCATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No..._44
5601 qy Town Soripter Home, 78 Park Street
Dist. No County 4 911 Village
or City (If city,give street address)
Name of deceased Tuffield Grundy
Sex Male Color Whiteo divorcedle, r(writeied, id}oe word) VVOdowed Date of Death August 3 19 38
Age 86 Years P Z Months z Days Birthplace Canada
Cause of Death Chronic myocarditis - years
Certificate was signed by Dr. V. D. Selleek M.D.
Address Glens Fali s, g. T.
Place of Burial (or Removal) Town of Queensbury, West Glens rails
(If body is to be teS o.ariA4ie14ons scam
later) August 5th
Cemetery Date of Burial u 19...5a
(If body is to be temporarily held,811 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 SATISFACTORYAS 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 James F. Singleton Glens Falls, N. Y.
Undertaker (Name) Inter (Address)
the to hold temporal' and the body.
(IInclertakeroKpers thpving chargg,4corpse) ter,re ove,or,6flierwis� a of[eta a how])
Dated �AUDI9 jhi 19 ' (Signed) ((//I-'
Deputy 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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