Gibbs Sr, Howard 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 Oi'
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No. 5601 Registered No. 33
Town
County Warren Village Glens Falls Hospital
or City (If city give street address)
Name of deceased .Howard....W.. Gibbs, Sr..
male VJhi$eSingle. married, widowed, married Jan.
Sex Color or divorced (write the word) Date of Death26, 1958
Age 63 Years 5 1lunths 18 Days Birthplace Albany, N. Y.
Cause.of Death acute myocarditis-5 days;.a.roeriQ—se1.e.r.OSts.R.a.t.r..Qphic cirrbrosis
Certificate was signed by Dr. Wm. W ,...BQ.wen M.D
Address Glens Falls, N, Y.
Place of Burial (or Removal) Qu.eens.bury, N. Y.
(If body is to be temporarilyheld_ S `
Cemetery Pine View Cemeter
Y Date of Burial Jan. 29, 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, AND "1'1 S 1 .\.'T(.)RY 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 Rogers & Carleton by Will Carleton Hudson Falls, N. Y.
Undertaker
(Address)
the to hold tempuiT. . ter the body.
(Undertaker or per on having charge of core) (L vm ve r pia r dispose of (state bow))
)al:•;1 Jan. 29, 19 36 (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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