Westcott, Oliver Form VS.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t2r 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. 706
Town
Dist. No.. 0?Q.1....County .. s '.ren. Village..5...C.harl.otte...St...,
or City (If city, give street address)
Name of deceased Oliver Johnson '(esteott
Male white Single, married, widowed,
Sex Coloror divorced (write the word)IA4.r.r.1Pa Date of Death Ju1y..la 19..3a
Age �' Years 11 Months 13 Days Birthplace...Brandtaf.,...Yt..
Cause of Death Hemiplegia: (a) Former hen4iplegia fb1 arte„r.1.9-sle.r.Q.s,is
Certificate was signed by Dr. Y. L. Havi land M.D
Address Glens Falls, N. Y.
Place of Burial (or Removal) Town of Q,ueensbury, N,t .X.,
(If body is to be tempozarily held,flu in space later)
Cemetery t• AJ.phonsus Cemetery Date of Burial July 20, 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 Harold C . .
]]yy Sta 'fo.rd Gl.eng...F.a11s.,...I1....Y..
Unde rt flKaem (Address)
the to hold tempor �T / the body.
(undertaker�person having charge of corpse) / ,remo , dispose of [state how])
Dated .LL7 19 ,.....19...38 (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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