Zimmerman, Alice NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Illy'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. 5955 Registered No.
Town
County Westchester Lewisboro
x �tx (If city, give street address)
Name of deceased Alice Irene Haight Zimmerman
F'emaJ� �Yhite Single, married, widowed, idwled Uet . 19 38
Sex olor or divorced (write the word) Date of Death 19
Age 81 Years 9 Months 15Days Birthplace Ionia , „iichi&an
Cause of Death "hronic _..yocarditis
Certificate was signed by Frank . Falkenbt rg,
Address .L.i1:.n.5 Fa11,.0. i+...Y... ...
Place of Burial (or Removal) Glens Falls, N.Y.
(If body is to be temporaril held, fill in space later)
Cemetery nine YView Cemetery Date of Burial CCU. 2l, 1938 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 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
to Oelker & Cox :::t Kisco, :..Y.
(Name) (Address)
the za.iader'.tta,.k. r to hold temporarily d re::loV 4X-Ici. ..ia; .0.1' the body.
(Undertaker or person having charge of corpse) (Inter, remo erwise dis of [sate bow])
Dated Qot . 20,E -93,8 19 (Signed) t
Local Regtstr
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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