Cavanaugh, Catherine NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
air 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 Oi'
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No....5.601 Registered No 1.3
Town
County Warren Village G1.e.n.e F.a,a..a.,e. B.Q.s.p.i.ta.1
or City (If city. give street address)
Name of deceased C. ,.the.lr..1.ne Ca17..a,IJia.la,ckl.
Single, married, widowed,
Sexk.',.Ql.a1e Color hitQ or divorced (write the word) ,J.I,.KI ,1.e Date of Death JaIIA 11 19..38
Age 79 Years 9 'Months 14 Days Birthplace +;la,shington Co . 2 N. .
Cause of Death Era..t.ur.e of Rt . f.e.nlur-1.5 d.aya;.LIy.o.c.ar..di.t.i.s.-2 yr.s.:..C.o.n.ge.s.t.i.u.e _ failure
e
Certificate was signed by GeorgQ M. Ca.qQy M .!)
..
Address �.-i,I.i. ►.S.c.n....Falls., 1::.,. Y..
Place of Burial (or Removal) Pine View CemQ#,Q, y,.,, Queensbury, '1. 3
(If body is to be temporarily held, fill in space later)
Cemetery .Ei.n.e Vies/ cemeteryDate of Burial Jan.. 1.4-., 19..3.8..
(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, ANI) :\"1'ISI ACTORY 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
R. T... F o t.t.Q.r Glens Fella,... N.. Y...
(Name) (Address)
He Undertaker to hold tempora,-i, . e.r the body.
(Undertaker or person having charge of corpse) _ ir. emo, erwise dispose of [state howl)
:)a .ci J.a.n.. 1.4., 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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