LaValley, Louis 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No.... _C.Q..____.._.
Town
Dist. No41.Pi....County Warren Village GI£.I A...k11.1s...11%Ispi. a1
0 or City (If city,give street address)
Name of deceased Louis A. LaValley .
Single, married, widowed,
Sex Male Color White or divorced (write the word) married Date of Death .NQ.V.....4 19.3a.
Age 60 Years 2 Months 20 Days Birthplace..... .ii.ngton.,...V.t.
Cause of Death�Y1o0afL'"thrombosis—few
hro OoV S D .houurrhs:Bilateal T,B,� 4 . .yearsCI.�y.,�-2t6.
Certificate was signer My... y years. Dr, John ti,� stac�,Q M.D.
Address GYeriS 'an s I . �.
Place of Burial (or Removal)t Queensbury, Na...Y.
(If body is tote temporarily held
rarilyy4 ill in space 1 miter)
Cemetery w�77Tt• P eBle exy Date of Burial No.Y......7.1 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 Joseph F. ReGan. glom k:al.S.,...AT,....X.
Under
the to hold tenlpora '1 ter (Address)
ndertaker(N the body.
(IInQertakk,r or_person having cbarge,,,,o�corpse) n move,or other apose of [state how])
Dated DI OO /A 19 `3 (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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