Ostreicher, Elizabeth Form TS.01. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Gar 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 CER'£JkH OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. �r t! yam/
Warren Vilt Town
/
Glens Falls Hospital
Dist. No 5601 County
or City (If city,give street address)
Name of deceased Flip,beth Ostrei,.chpr
female hits Single, married, widowed, widowed aareh 4 38
Sex. .e.m Colorer or divorced (write the word) Date of Death , 19
Age Years 3 Months 19 Days Birthplace Vie-rms..) •Aufyt•ria
Cause of Death QhrQ1 ic ;:;eppar.i.t.i.S.-Z...yrs-ar'.td.e.rims.a.1.er..asis-.3..; rsmaeriili.ty,a..yrF.
Certificate was signed by Dr.......F.dtaa.rd..J......F'.i.t.zGera.7..d M.D.
Address Gl.ens...F.alls,....Li....Y..
Place of Burial (or Removal) 's'r''.•....G...e.f}•s...Fallaa...l .....Y.
(If body is to be temporarily held,fill in space later)
Cemetery St:..., :PhP.Asu.s...Qelne.t.e.ry Date of Burial1ar>wh...a, 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 S. T. Potter Gl.ens. .F.al.1.s,. .N.... Y.
(Name) (Address)
the UnclQrta::ar to hold tempor • r the body.
(Under_taker or person having char a of corpse) I emove, iapo e_o=state how])
Dated ',iarc4 73 108 (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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