Haines, Laura Form VS.61. 10-21-37-25,000(17-3459)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
AS' 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..
5601 Warre Town 13 Cunningham Avenue
Dist. No County xi Village
or City (If city,give street address)
Name of deceased Lt ura fl, Ha.ixic$
Single married, widowed
Sex FemaleColor White or divorced (wite the word) Married Date of Death June 5 19 38
Age 81 Ye rs 5 Months. ... .8...... .Da vs Birthplace New York State
Cause of Death .hronic myocardifis . years
Certificate was signed by Dr. James Shields M.D.
Address Glens Falls, NY
Place of Burial (or Removal) Town of queensburjr., Warren Co. B.Y.
(If body is to be temporarily held fill in space later)
Cemetery ID LW V'i.?.w Date of Burial June 7 , 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 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 atlwa.xd...T.....P.at.ter Glens Fall s, NY
Undettakdme) Inter (Address)
the to hold temporal' and the body.
(Undertaker or person having charge of corpse) re ove,or otpeFwise 1• o![state ow])
Dated aline. 19.3B... (Signed) �puty 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.
•
r1-1'0 '"''00A' c 05.E e4 � •n, » E.O » ° o r"..° gb ° 8•°.° oc�a•°,s745•� dp• _ 'p'^^ d
oZ,� ., p � �<oq'Ca � -, ow • a » �orw �aaa ., mNoo ym ti:� a t!j
•, gp ., Ramie CC•..w �'•� re red O .° 'O •, C m
;;z `° 3roo,-• wp '+ owo-wwcmc ou _, F;o (0ca' .W•, pccp �'-•-, Na•oE;� vo oS -, cnan to tCr1 r./2. m 1'
x• a•*5�ba ° aa.d •, C ° ° co iv oc<oi;►, Ca,y_. ° o ° cn� .b y o
70 w O ', a9aw ., re 'ww.'..o' •op owr- 0r, i w ° ' ::b ta-, c w o Zm w $, o d
12Zi `e < COn) ° 0`eay "= OD:C7co rO a.w.1^O •-1n' 5 co r� .,t rc Si) •N.,.O � '.1 7 y 00pV
m r w U' N re pl, .- N ,., N •y .+ ° w a _ y •, p O ° w I\a0 m O
p.,•r�m t+1 w cyV, .°+. .+,w .��. ,n N ° ••, a• a(.•• ^ ct. ° Ca•-he P C ❑ re K N K° p. -' V
.. •1..k ° ro o o w w 5 ° ° n,, w ° fD E e a5 .rr° ° o � .Cvp
•7 ye r. •o fie ° a,°.„ o a N 3 *'.w. N •, C .� o
y050 -, � 5 ° 3 �w ° 5 � ° o°' < " *oo ov�fe � y, =; a?;ea � � •r°' m moHd� 'OPr1
dm 2 5 N 5 :., o Et-sE.-••5 w i °,o w C *O'o 1?o n ° v, fD ''•0-w =°:°,.e -, a.9, 6 r��• °a. tnm•n '
mg ir
aO..v' ° .::� eA•m° °•oa `e o, H� Nmo w ° F..NS.°.w `^.,yw ° •, QA0ccaa Ill
; r o m Al 0q'' O•o A ° a•, a° N m Z y ° trA%-, ° a •
a.$) § a r:w ° `�° ' `t.6•"e I•: 5... � g z •s
m , p O •° ° aree,�° 0 °'o-2 ° E. - ° 7, �.0 a.� N'r�e � •� O ,°.?'.O w5'»,A , a w,oq $y
m v °" c� 5'o-C .,! 8yro -tyaAL• � 0. � to.EL .w5o�..•'�•,-.., -Fe,e •-•a•a, ..K H 0 °099c m r..
ACRfC '+ �ogaaw0-o- 0 V. ''C.o •"a,o.w p 5 N' yow ?:0 , NS'o'o •wo- tn bo89 � Aye
;'"n0 d O C 5-Pr' °, rD G 5 O w [o 0 -T.•K .+ry �,"a° f0 rXo �• ,.., —„CD P ,, w t.Py� rD N '^I '.N 2 O r CA dp <m ea► ~N�
BOa 0 et, qto- y0 •°bo -, 50• z•O ./ grow0 0-5-"5i-'�'awe:o w '2'1 ^ Colo., „El
p. oe•-, ,.„ 2 '^'' ,i Cr .0 :: ° 5S °'�a ^a_ , o --off° ° �° ° c$o ° , .r tr em Ocn
m 5'r, wO •, o a• -, . a•.. w R' w -, ate. e.w rpm ° e, P, o
r. H•„H re �:_ ° ro � ro � N NO° rer„ ,° C � O ° o ., ..+ o »"� mE . x�l
0 o6'ao o ••o o m ° 5» ro x o K H a
Sx ap' 0 " ,o e....,Cw ° p wwXMo'C °, ti bO ° r°o ° O in °•oa. ° 6. C) n
�t*f0 N•�^ oeoo'w�o `n ° ' ° ° ?' w � o » or, '° "' e ° a o a-, � "'I'' C� Ya n ` , yC�
0 ro »,o ° -, ° ° ,, N � c, _5 5' r, o n •-, of -, ° o < ° co Crl .HA 4 : i' ~
.1.1..1 4-_ ., ° ° ogK Q'o =cgaCr, tiya ° c a.a. 5• ° B £ ;.
m cn ° g<.o ° °•OR ° 5 r.0' CD 5w° =•^ �' o w.°i000ww " ''' fo0."-'" C." o o:yu S,• ;, '�''� OO O
'w -, , + ro ° �°a� cJ ao E. re ONw C -- ro ° n e C D
p p •o oa a+aYro -wi r?w 5 <•so a o o N fe,e "P' �rs� `e =" o•�,"" i, 0. ° u A
•�' C cR 5 p' F�M
.m H 001. 5 e-waq o•N A G•p,, ti0 CT»•oq e••,3 C•° -, 0 ,°-n° 7Vi ,„,-•0 ='_ w o•�' w ° ° p' N O ", e'rr0
�c 0 m '.,�w0 < w.wry �•Na •�i�04 • 5•K ao' o.� w O'rt �0 y `w^�., •°o, cy 0 ag.n a, no
- "� —
•n►17 ° obo'•_? 8 ° ".' 0 ' 05.9a••' ° wpi •o C'C »,C O •, aw •, ._Art~ 8 ,� w 6'.."r1Sp el a°W .w. C • MF ., aro ° N ° Sw 0 , " »,., mroco wO m m O •1,
o a K ao 0 5w ,+ c55° • o at , m o •C�1 �NN ° wa O ° C P, ° N CO , yGq , p, r^yrD .aoo � C CA m m o .��Ia�
•222 o•° 8'0 =-0 -rex —.;',5.e ° 0on ., < £ O ° ° O rp7aow0 G R O ° A'� '0A m O G� v r`1
v tl'1 ° g^•'o 'w+ e•° o•� ° 5'y o o 0b,y aw .-, 5-�° y cao o r"o•o '•;�'w .n. °•o•go tr.
a a+ °p �"�
0 7 ° xt . ., co co e• ,,, ° ,
" ° Oro CA ^,Oq ,C r. .. Y ., .° ., 5 ro0e•G,ap rose d 0
e „ltt11 ° 7-»,N C N•(D ro SN• C. ° = ° rao ?N ^ •W •+ 0 F _.•0 .. -i w & 0, Ha 0 Cr7C71Z
"o',ed1 0 •-1 *e •w, T*s,�w.rym I -, °, r°n O ..•n0Q :+',*r~e � —0 '-' rC0- (1> Z5"•OKC• ° ° rao w Er P+ Ir
m .,02 •-i Mco o co ato )• g.ao 0Ho ,.•000P 0 0.•,° � rfe3N � •, CG_,awH;., "p mK 2',...
^!A ..,. ° °_ ° OOg Orrin .`S -•p,N •°•.,° �,N'rN* �,C,� N Or,..9 < 0:2:4 M ".Cwa.A O.rm a-.9,
0 u. re cn � oNOO •, wo,K •p ° o: ..o �i•, w o .+5 w ° 5 ° Fyy a'ag0a• U� • 1H�'^w �l� yA
p ° O N o'M 3 a5'►, ° y O 0 0. y,ty ..?•, p," ° w5. ", V, M N C Myw t p.
a � OGN ^'O ° ?•, Rx o'C.RyC"° ,•,.•, O N C = K, .1 ,,-....,w ° ,� »•° ° g l,Oq
•V o ~° oowow o•r.8 ., oco .to o •, w 8 -I ° ° ° oe ° ., ° �.,e ›, xmm
;• V' ,. o-N- Or, -, 3 ° oa' Ogwa r,4ow ..,,o ..•ip, � .< a•, a-g•, c 5St» 0 '� o d �Y
ma ,* ° o ° o ,,, o•aa,, -, o . to •o- Np coW w ° ° .o o •,.
C e•° cm c ro p ro *.-a p, eb o o ro C H tO a
A mxm • ., »,p =-04— , ° ,N,• 'O .o. O o`G 0 5'., 5'° ° N ° •, a < n N ,,, wm i Pi
O w ° �- w 0'S » ro »- e o ° N N o a . 'w N w o o w Scr �,'
o ° K r, 'w N •... ►, w-. •c;a o ', •, w o r, 5'..a', w •
^� i0m ° 5 ?' o ° ?'.r, ow o 5w o cro », w -•,.. w _o m 5
w * ° �., moo •, < B o•�•eo w a •, •, o ° roo 0 C.► t
,..
o3e O 00 - e °•e ° ° g..^ °pMo• 5gc°np ° ." n0 .° w0a"020V tcf60 CO LTJ
y 03 .,,C., N ?:sr `�° Cr� o , •, . o-m .w < 5 C ° 5 0" 0 O v 5 0 ° m d�.
•72 S•.,,•C,5.,p 2 5•a0.o•r•O N S.° 0 o•w, ''.°+.<•• °'�' rae < ', p'°b ° c N 5,,''.G y ^'c x 'w O
R• », o'roe 4,c0 i� CD as y o'N'O•.Q O 2 ::N ..-..N p 5'w `! °, C.r e �•0 a.5'w 4 w 0•o 14 0 a.A"°a a' �7