Suprenant, Lioda NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
: '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.
Dist. No........5.6.01 Registered No. 1 5
Town
County .. .rren Village Glens Falls Hospital
or City (If city. give street address)
Name of deceased AttQ.da C. ., .uprenant,
Single, married, widowed,
Sex....L.0.i13.21. ;olorvzbitte or divorced (write the word) married Date of Death Jan 10, 1933
Age 39 Years 11 'Months 4 Days (4 mos) Birthplace Cheney, Ontario
Cause of Death..1i11.?.t.1dr.O.51 au.cl9minal pre .nancy.... iith severe haemorrhaEe-i e:r hours
Certificate was signed by Dr... Jo.hn....H. Sh.e .d.an w M.D
Address Gl.e.ns Fall.s., N. Y.
Place of Burial (or Removal) W. Glens Falls„ N. Y.
(If body is to be temporarily held, fill in space later)
Cemetery St. Alphonsus Cern. Date of Burial Jan. 131 19 38
(If body is to he temporarily held. fill in space later)
The Certificate of Death containing the above stated particulars. having been presented to me, after careful examina-
tln, the same appearing to he COMPLETE. CORRECT. AND SATISFACTORY AS REQUIRED BY LAW.
T 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
L.�.o.n.e.1 J... D.o.]rvi.11 C ens Falls„ N. Y .
(Name) (Address)
Under.t. .ic.e.r to hold temport •• nter the body.
(Undertaker or person having charge of corpse) to .move, or orherwis dispose of (state howl)
;...J.an.. 1.1.,. 1.9.3.8 19 (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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