Howe, John Form VS.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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.
Registered No......_..0__......._.._.._
5601 '+'Tarr Town Glens Falls Hospital
Dist. No County �Xl Village �
or City (If city,give street address)
Name of deceased Zahn..:li,....11.a2¢e
1"ale '�vhi to Single, married, widowed, married Oct. 2 38
Sex Color or divorced (write the word) Date of Death , 19
Age 65 Years 1.1. Months 14. Days Birthplace..G.17.e.S.tr.erIca.ml.d...N......X,i
Cause of Death....Cri.r.ol.la: Rr'Y...Q.Qa,1aX.n...r.Q11,Q?YYa,ag op.r.St.1.Q1:1....a ,Y....Q.11xa. !4Cgkrai.tc.i.P ,
Certificate was signed by..41: QS'iO—$Q1Q 'Osis s.UnikpoWnt Dr, E, B, ProbasCQ M.D.
Address uU.0.115...F.4iiis,...N..,...X...
Place of Burial (or Removal) PjJ.? View Cemetgry
(If body is to be temporarily held,fill in space later)
Cemetery.....1.in.e..M.e.W...C.eme.t.exy Date of Burial Q.c.t......5 19.Za.
(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 Orville VIA CQ11.3,xls Sc• Glen Fll.l.rg.a. l t... a
U (Name) (Address)
dgtJet
the 11 . to hold temporar. .0.r the body.
(Undertaker or person having charge of corpse) r ve, se dispose of[state how])
Dated 0Q tQ?l.e .. T..,. 19t3.a... (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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