Bentley, Philip NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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. 56.01 Registered No.. 44
TCounty Warren iian
ge. Glens Falls Hospital
or City (If city, give street address)
Name of deceased phut,p Wayne Bentley
(( Mite Single, married, widowed, Single Feb. 38
Sex. a.A Color or divorced (write the word) g Date of Death 6, 19
Age Years 1 'Months 7 Days Birthplace Hudson Falls, N. Y.
Cause of Death circulatory f.a tl.lrlre-Ma 'a. .p:!u .,.. .urere malnutri tion-lMo.6 days
Certificate was signed by Dr......A. W. Qhapman M.D
Address Glans Falls, Y. _.._._......_._...
Place of Burial (or Removal) Q.u .onsbu , i.,t.....X•
(If body is to be temporarily held, fill ins ace later)
Cemetery Firie V .ew Cemetery Vabli, Date of Burial Feb, 6,, 1938
(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 examina-
tion, 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
Harold Cx Sta. fQrd Glens Falls, N, Y.
(Name) (Address)
the Vndertaker to hold tempor. 'a • lace in vault the body.
(Undertaker or person having charge of corpse) em ise dispose of (state howl)
Dated Feb. 6., 19.,3$.. (Signet _ _.......... ......._...._ m_...._.....
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 reguiations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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