Goodness, Louis Form VS.61. 10-21-37-25,000(17-3469)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tgr 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..._._2 79..____.._
5601 Warren Town 15 Wing Street
Dist. No County Village
or City (If city,give street address)
Name of deceased Louis J. Goodness
Single, married, widowed,
Sex male Color white or divorced (write the word) Married Date of Death October 6 A 1938
Age..EQ Years 3 Months 11 Days Birthplace Luzerne a N. T.
Cause of Death Rt.Lobar pneumonia 3 del; chronic bronchitis; time unknown but part
Certificate was signed by_. -ieaily rot teas Floyd Palmer M.D.
Address Uiens Falls, N.Y.
Place of Burial (or Removal) Tom..Qt Q1degXl.$.?U, 'Y
(If body is to be temporarily iiatiel Viewiater) October 9th 38
Cemetery l Date of Burial a 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 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 Joseph F. Regan Glens Falls
UndertakA ame) Inter (Address)
the to hold temporari d yy�� the body.
(Undertaker or person having charge of corpse) I r,rem e,brdith p se f[s bowl)
Dated Qi ta,b.e.x..8th 19.. .. (Signed)
e uty 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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