Pharmer, Delima 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.....236_._.
_
Tarn
Dist. No5601 County Warrens 6 North Delaware Street _
or City (If city,give street address)
Name of deceased DirliA0. ...Plus Clem
Male Whit a Single, married, widowed, Widowed Augt 20 38
Sex Color or divorced (write the word) Date of Death t 19
Age 78 ' Years 8 Months 12 Days Birthplace Canada
Cause of Death Cerebral hemorrhage 3 mo;,arterio sclerosis xtime unkngwf
Certificate was signed by Dr,Floyd. Palmer, M.D.
Address GL eY$ k`e,l :. .,.... ?a Y,
Place of Burial (or Removal)...T.QW31...Q....Queensbury
(If body is to be temporarily held,fill igppa:e Iskteirl honsus August 23, 38
Cemetery 77LL k Date of Burial 19
(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. Reean Glens Falls N. Y.
the Undertalger) to hold temporar. and Inter (Address) the body.
(Undertaker or person having charge of corpse) r,re ove,oryre a ee o![state ow])
Dated Migll .t 23 19., a... (Signed).... („ ......... ..
eputy 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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