Hunt, Edith Form 7
) PLACE OF DEATH:DIRT. NO. /JON PERMIT FOR REMOVAL AND BURIAL
Original COUNTY OF_TINA An ales_ THIS IS NOT A DEATH CERTIFICATE LOCAL REGISTERED No
CITY,TOWN-Olt II'-'a__
aJICAI nISTRICT_QL CLRn}tTva 11011Ti nn STREET AND NO._RRTItJ Mani Cg1inttri till
2.FULL NAMF Fiji th Lake
Mutt [LTtn}.____ - _ _ _ _ IP MATY Occ[l[HD 1[A MO[nTAL OR wTrtunOR,am ITS NAME ISITLAB oP ITEM Ann.
'� _Lane. George - CITY OR
R TOWN, A,DST Lake SteorgeD_PIew_York_
RESIDENCE:No. __-. _ST. CIF NONWESWH,AN Gra
a -
O 3. EA 4. OLOR ON CE ,SINGLE. MARRIED.W IUGWLO OR T I $
I��
DIVORCED? (WAITE nit Yonn) 22.DATE OF DEATH Nay 16
w FP1nsl a White Widowed NDNTN DAT YEAR
a SA.IF MARRIED,WIDOWED OR DIVORCED.NAME OF HUSBAND OR WIFE 23.MEDICAL CERTIFICATE OF DEATH 24.CORONER'S CERTIFICATE OP DEATH
H Wm.John Hunt I HEREBY CERTIFY. THAT I ATTENDED I HERESY CERTIFY.THAT I TOOK CHARGE
DECEASED FROM T915 OP THE REMAINS DESCRIBED AROSE. H[l0
y 6.DATE OF BIRTH April TA IREE TO My 16 I938
F. npu?R On TEIR +_
Q 0 28 I IF LESS THAN THAT I LAST SAW H km heLLIVE AN
Z 7.AGE 77 YR. MO. L�—DAYS. ONE DAY_.._ _HRS.--MIN IeB.LST,Autopsy OR uouuT
a g 8.TRADE,PROFESSION OR KIND OF WORK DONE OH MA; IA THEREON, AND FROM SUCH ACTION FIND
W - AS SPINNER,SAWYER,BOOKKEEPER.ETC. HQL 9PE1 fa AND THAT DEATH oCCURRED ON THE
QI WI s 9.INDUSTRY OR RUSINESS IN WHICH WORK WAS ABOVE STATED DATE AT THE HOUR OF THAT SAID DECEASED CAME TO H
,e4 7 DONE,AS SILXMILL.SAWMILL.BANK.ETC OrD hom0 TT.05 p y DEATH ON THE DATE STATED ABOVE.
y 10. DATE DECEASED LAST WORKED AT U.TOTAL YEARS SPENT
0 THIS OCCUPATION ISo.ARC YRn_ IN In s OCCUPATION__.-_ THE PRINCIPAL CAUSE OF DEATH AND RELATED CAUSES OF IMPORTANCE, IN ORDER OF
Er)pH NJ ONSET, WERE AS FOLLOWS: gyp-N�OF ONSET
pH x 12.BIRTHPLACE lair OR TOWN) T Ake-GPnrge _-_ ortensi v9_e^HeartF_ disease rum
own
aSTATE OR coups TNT__ ew__.yor_ - —-- with 'UOeompena°tins ----
H 13.NAME A:rhnnsn_Brown _ _-- --- -- - -- -_-___ _ _-- _- 1I 1-1 -
1 < 14.BIRTHPLACE CCITT OR,...)__Lake George OTHER CON LR:CUTORY CAUSES or IMPORTANCE:
York
enn 0 IUT F. = - WAS THERE
MAIDEN NANF EuniC6Mead----_ -_ _ _ _ __ -_- IE y
F4 Z 0 16. BIRTHPLACE(CITY OR TOWN)_Lake George___.__ (II OPERATION. DATE OF AN AUTOPSY J e$
H. i _kvle- l
F) M STATE OR COUNTRY _YOJ%R CONDITION FOR WHICH PERFORMED
FcI A. CITY.TOWN OR RURAL NAME LABORATORY TEST
w Q CONFIRMING DIAGNOSIS
y F D DISTRICT OF DEATN_TRS._8 _vOS DAYS
ZHN LO 8 25.IF DEATH WAS DUE TO Eti[RNAL AUEES(VIOLENCE) FILL IN THE FOLLOWING:
✓ �u I.IN CALIFORNIA YRS._ MOST DAYS ACCIDENT,SUICIDE DATE OF
AF( e n� C. IN U.S..IF OF OR HOMICIDE? INJURY
III w1 0 FOREIGN BIRTH_ -IRS. _ W . MHOS. DATT INJURED CITY OR TOWN OF
KI 18. INFORMANT (SIGNATURE) �1eleII-IYSEi EE1Ber ----- At 11 COUNTY AND STATE OF_
!I�'I ADDRESPT6 Notteargenta Pacific Pali8adec DID INJURY OCCUR IN HOME. -- - - - - ---- - - --
>HI ---- INDUSTRY.OR PU[LIC PLACE'-
a MANNER OF
19. BURIAL,CREMATION OR REMOVAL 1_RPI0.nQjL/ oEq J INJURY
PLACFLake George.New York R Rnc nDATf/71%30 INJURY NATURE
OF
a 5p3q.8� 26.IF DISEASE/INJURY RELATED
{LICENSE No-1I.539 TO DCCUPAY:ON. SPECIFY
Of 20.EMBALMER{
GBL SIONATURLGrant Leslie
1„1 FUNERAL qq 27.SIGNATURE Alfred A Koeksf
DIRECTORTOd & Leslie Inc. D.
a j'}� nlmCIAN.AUTOPSY SURc R
ADDRESS B anZ{}a- i& Ornia - ---- ADDRESS 1250 - 16th Str.Santa Monica
21. FILED - . - 28.WHEN REQUIRED
LATE BY LAW _--.-..- --_CORONER
_ LOCAL limn)* COUNTY OE _ - __- _ _ -
LOCAL REGISTRAR'S PERMIT FOR REMOVAL
N. B: HIS PERMIT CAN DE SIGNED ONLY BY THE LOCAL REGISTRAR I DEPUTY OR SUBREOISTRAR) OF THE PRIMARY REGISTRATION DISTRICT IN WHICH THE DEATH
OCCURRED AMR THE FILING AND ACCEPTANCE OF A COMPLETE AND CORRECT CERTIFICATE OF DEATH LEGIBLY WRITTEN IN DURABLE BLACK INK.
A CERTIFICATE OF DEATH HAVING SEEN PRESENTED TO MC. AND AFTER EXAMINATION THE SAME APPEARING TO ITS COMPLETE. CORRECT AND SATIS-
FACTORY AS REQUIRED BY LAW. I HAVE FILED IT WITH THE ABOVE STATED LOCAL REGISTERED NUMBER. AND ON THE OASIS THEREOF 1 HEREBY GRANT
A PERMIT TO THE ABOVE NAMED UNDERTAKER FOR THE REMOVAL AND BURIAL OR CREMATION OF THE BODY OF SAID DECEASED PERSON AS STATED ABOVE.
IN THE CASE OF DEATH FROM A DANGEROUS OR COMMUNICABLE DISEASE. THE BURIAL OR REMOVAL MUST BE CONDUCTED ACCORDING TO THE RULES OF THE STATE
AND LOCAL BOARDS OF HEALTH. // ) /Jn - a, c /]��--
MAY 16 1938 ,l/)L «A
DATED_ -19— BY- 1-L'�
CLERK
THIS PERMIT IS SUFFICIENT FOR TH. REMOVAL AND BURIAL OR CREMATION OF A BODY AT DESTINATION AS ABOVE INDICATED (SUBJECT TO LOCAL CEMETERY
OR OTHER REGULATIONS).
Endorsement of Sexton or Person in Charge of Premises on Which Inter is or Cremations are Made
o
( E OF PERSON IN CHAR-L OF Cumsue:)
DATE OF INTERMENT OR CREMATION HIV
(STRIKE OUT WORD NOT USED) (NAME OF CEMETERY. CREMATORIUM. Etc.)
ORIGINAL-TO FOLLOW THE BODY T TS DESTINATION-IF BURIAL OR CREMATION TAKES PLACE IN CALIFORNIA. THIS PERMIT MUST BED L DIED TO
THE PERSON IN CHANCE OF THE CEMETERY OR CRE ATORY BEFORE THE BODY IS BURIED OR CREMATED. THE PERSON IN CHARGE MUST RETURN 1 ROPERLY
FILLED OUT. TO THE LOCAL REGISTRAR OF HIS DISTRICT WITHIN TEN (10) DAYS FROM THE DATE OF INTERMENT OR CREMATION. IF NO PERSON IS IN CHARGE. THE
FUNERAL DIRECTOR MUST SIGN THE ABOVE STATEMENT. WRITING ACROSS THE FACE OF THIS PERMIT TS:E WORDS "NO PERSON IN CHARGE" AND FILE THE PERMIT
WITHIN TEN 4 10) DAYS WITH THE LOCAL REGISTRAR OF THE DISTRICT IN WHICH THE CEMETERY IS LOCATED
STATE OF CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH
°Cu 120G WM VITAL STATISTICS
SIA1(P1.1.IINC0111CF