Landon, Sidney Form vs.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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..._..1. ,.2_..._........_.
Barren Town
Dist. No 5601 County Village...7...Fine...5. .,.s.Q1.g.ap...Fs D-.P.a... +...+e.........
or City (If city,give street address)
Name of deceased Si. Xley 4'e Landon
sex male Color whit eor divo edr(write ldowed the word) Single Date of Death APX'i X...6s 19. ...
Age 9 5 Years 6 Months 17 Days Birthplace Ch iP s t c l'tpWX#o..•.N>< r
Cause of Death M,yocarditis-4 days:arteriotlsolerosis;FrAcAure...Eight. Hip
Certificate was signed by Pr Wm. 71 p Bowen M.D.
Address Glens Falls, N. Y .
Place of Burial (or Removal) Qu.eaxlsbury.a...N.....Y..
(If body Is to be temporarily held,fill in space later)
Cemetery i ...Ili.e.w...11eme.t.ery Date of Burial April....9.,. 193.8•••
(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 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 S. T. Potter ma .F.allia. I:L....Y...
(Name) (Address)
the L'ncl.?X talax to hold tempor �q� the body.
(Unde�taI ot�peg�pnkiving charge of corpse) (I oTrS,or t ose of[state how])
Dated t✓` ' 1 I 19.38.. (Signe
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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