Weaver, Eudora 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. 256
Town
Dist. No56Q.1 County ;barren Village 1.7 ''o.I1t.cal.m...St...,G1an•s•••Fall&. .N. Y4•••
or City (If city,give street address)
Name of deceased Eudora Weaver
Single, married, widowed,
SexFP.??;4.1.Qr.Color.Rtht .Q...or divorced (write the word)...alarMie.d Date of Death Se.p.tember••1419•••38
Age 5.2 Years 4 Months 27 Days Birthplace Ticondero ..1...N.•.•X„
Cause of Deat1Porona Y O?Ql.u.5103.-.1....day....C.b mal.c...Myo.a.arcs.i..tia-:.5...yr.s...Chr...E.nd.o.caTdi•ti,
Certificate was signed by Llr'....H.....A.....Bar.t.l:o.l.ome.w `•.x••*lib o
Address Glens...F.al1s.,...N......Y..
Place of Burial (or Removal) ,+s Caezi,$...k'.al.a.,..I....I..
(If body is to be temporarily held,fill in space later)
Cemetery St......11. harislts••C•ezie•tery Date of Burial Sept . ] 7 ,. 19...3a
(If body is to be temporarily held,air 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...LiOnel...J......8olv.i.n , lens••Falls. ..Nv .Y,
(Name) / (Address)
the Unde.r.t.aket to hold tempora ' ' T+ '�,. the body.
(Undertaker or person having charge of corpse) y , !move,or . . • dispose of [state how])
Dated �Se a t....15•, 19.33.. (Signed) k
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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