Thomas, Baby boy Form VS.61. 10-21-37-26,000(17-34d9)
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 CERTWMt TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.._.__. .U�_____._._
5601 Warren Town Glens Falls Hospital
Dist. No County Village
or City (If city,give street address)
Name of deceased Baby Boy Thomas
Male2 i°�llite Single, married, widowed, single March 30 38
Sex Color or divorced (write the word) Date of Death .i 19
Age S".IL .e T : Months Days Birthplace...G...en.$...Ea1.J..s.p...N....Y.a
Cause of Death Aq.phyxigt. egpatorium
Certificate was signed by Z)x'.....H.4l?f/aX.d...sl.•... . t.z.g.exeil.si M.D.
Address Ga..eX>,s. .F..ala..S.s. .N.....X.
Place of Burial (or Removal) G ens. .Falls.,. . ....Y.a
(If body is to be temporarily held,fill in space later)
Cemetery 3.i......a.p ,QX?$us...c.Q.me t.ery Date of Burial .r.g.t/.. 0., 19...8.
(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,, .hey basiseTGlens thereof I HEREBY GRANT A PERMIT Falls, N. Y
tob tr Y.
(Name) (Address)
the Undertaker to hold tempora i per, the body.
having
(Undertaker or person charge of corpse) n bae, . spose of[state how])
nc Dated Mah...'.zU, 19...3B. (Signed
Local Re strar
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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