Cole, Charles el- -- NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. .5.6.01 Registered No 10
Town
County, ` ari en Village 2 11Q1n.1, Street , Gl. .ns....F..a.l.l.s NY
or City Ili city, give street address)
Name of deceased Charles W. Vole
Single, married, widowed,
Sex M Color whltivr divorced (write the word) Widowed Date of Death Jany 6 19 S?8
Age 76 Years 11 \lunths 2 Days Birthplace ,W. , :r.4'.rat?.ur. ., N.Y
Cause of Death Mesenteric Thrombosis 3 days ; lobar pneumonia 14 days
Certificate was signed by Dr. Roger Mitchell M.D
Address Glens Falls, NY 191 Glen Street
Place of Burial (or Removal) Twe Town of Q,ueensbury, P
(If body is to be temporarily held, fill in space later)
Cemetery Pine View Date of Burial January 9th 19 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 examina-
tion, the same appearing to be COMPLETE. CORRECT. ANI) 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, Stafford Glens Falls
the Jnderta ' to hold temporarily an Inter (Address) the body.
(Undertaker or person havingof og
se) Inter. re o• , o e d.sp Isnte bow
Dated J charge January 8th 1900 (Signed)
eputy 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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