Bickley, Joseph Form VS.01. 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 CERTAFISATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No......_...._... ....._ ._._
T
Dist. No560l. County Warren Vill ge 16 Broad Street
or City (If city,give street address)
Name of deceased Jos@ith 't .Bickley
Sex Male Color white or divorced (write Single, married, idowed,the word) Widowed Date of Death August 31 19 38
Age 92 Years * Months Q Days Birthplace England
Cause of Death Chronic myocarditis
Certificate was signed by Dr. Virgil D. S e ll e c k M.D.
Address Gi en s a11 s
Place of Burial (or Removal) Town of Queensbury
(If body is to be temporarily held,fill in nice r1
Cemetery Date of Burial 19
View September grid, 38
(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 Seward T. Potter Glens Falls, N.Y.
UndertakerName> Inter (eddresa>
theto hold temporaril and.... the body.
(U grta erorr person having charge of corpse) , e ve,giher s ! how])
Dated � aij .0.i.�.19..v' ... (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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