Warren, Andrea Form vs.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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.._..2 B......._.__.._
• Town
Dist. No 5601 County .' arren Village Glens. Ffits•...7y r..,.)
or City ( i�,gitet�ad )
Name of deceased .d.rell.. ans...7arr.en
Sex Femal color white or Single,
dr((writed, e the word ,S 1. Le Date of Death Nov 19.
Age Years ""' Months Days Birthplace G�.elas...F.a1.1s4 ..Y.W 38
Cause of Death
Cerebral hemorrhage-2 days„.,(,cau.sesi...b.y slystocia)
Certificate was signed by Dr'..... .w...,A.....B...r.tho.iome.w M.D.
Address Glerls ;Fiala.. N',. X,,
Place of Burial (or Removal) cT,own, of ,Q.w.o.n.lorry
Cemetery(If body •to beWtporai3.L fo11SU in sa( eme t
1 �`I qrY Date of Burial TaO.3I......5.r 1938...
(If body is to be temporarily held,till 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 Tose,ph F. 2egap, G1sns...Fal.l.s. i:.....Y,,
the Undertaker(Name) to hold tempor ' .tar (Address) the body
(Undertaker or person having charge of corpse) j ( remove, se dispose of[state bow])
Dated ovs 4, 19.313... (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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