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Denton, Beecher Form vs.et NEW YORK STATE DEPARTMENT OF HEALTH OFFICLAL BURIAL (OR REMOVAL) PERMIT tir 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 CERTIFICATED?( F DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.......,1 <2 .._ _. Dist. No..+.0.Q ...County Warren Vil age 57 Knight $t; Glens Falls, N.Y. or City (If city,give street address) Name of'deceased Ilegeohor... a...Mmal.S?. Single, married, widowed, Sex...M&le....Color.Whjte...or divorced (write the word)...X0Xr.ie.d Date of Death Apr..11...k.2r 19.*11.. Age 82 Years 7 Months....11 Days Birthplace 0.1Q 1B rf a.l$.t... .....is Cause of Death Gp4ro.imaAils...Qr....ckQ.ill#.o.b4....aria ".QTa .S3....GllxdifJY. o ae.r..41.440.a0.0 _Certifica.te- was signed -b}. ... i,rii3r-Y: T-$ t._ - - - — -_. •. Address G1e.na. -Fails s 1N.,., T. Place ,f Burial (or Removal) Neat...Glens...FA.lh0,... ,....I. (If bode is to tee orsrly held,Mkt War) Cemetery West G1.Ins rail* cemetery Date of Burial 4,p..p,1, 2 tix.t, 1939 (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 6.R...L......PQ.tter glots calls. N. Tt (Name) "Address) the Iutl9rt1Etker to hold temporaril and 1J1Tl.r the body. (Undertaker or perso .paying charge of corpse) (Inter re ove,or o (state bow]) Dated.....112 r l..." s.�Z 1- 19..Z9. (Signed).... Local Registrar • e, This Permit is suf{icient for the Removal (and Interment or C emation) of a body to any part of th State (subject to local cemetery or other rein..:ions),unless rerneeal is by common carrier,in which case a Transit Permit (VS No. 62) is required. r»y'e wgOP cto;s.s ,cngn 01 woo A [" y a•.•'=S A n " o•D K. zi O y ^� '^.. ry .+.•»+— . ,* '�»,0 .~ ,0 A 01 a o g^�3'I O O R.p, E7S+""1 �'.0 wse se y Zr. 0.^�ac<ba A•y?•ouw--. . a.p.0awa� •W~ R ^ ~ '4�b•�Aw ^ hro co ASP `. 'A • 1 w p " o.s 8.w " 5 r'wp� O.y p• ^ G/n Nth gnu. .aw w., �O� �.+OA ^ V10 iti• ' si*O4s rJ e m,. '< p•< p•O " A p . -t —O OD. .S7 O'-S....,n -, ..:i p Cb ^ •, a ., .- ,.w O • p fi. P. VS 9. " tef 1'.w +�' p •, y ou.y .., AA �w•, O' �•pt°x�. t= °� os ..i m .-.0 o =5,0.Qw es- :i • v .... o k g.4 p.u .•w�p 4., = w V1 0 et, tt- �.T L.• A o p ! a ee w m b*A +�cr V (j.�� O .4a„i p, A A .°i. c O a.u'g " I. N •w ^ .Ny .* 0.Qp'' is*.^ Kf '�F� L,y f/� �Q ., 0 ^ g y Sn A F. �•0 0 °. *T n.� V M...ro y p 0 A < w y "O)4 W ��'"r a �.. a a'o A y c.w o " A CS � C.. •*u � e� xtar' ^ �=° 3e w -� a ... ^ o•.. ,. ��'.* < Ap� :+•R `�+�1�C{�a, eyt+f �o* z coo .4•3'b.1 ^ a ,T=;bc•g `°^`4 -C,..,� g'7 ggo y � "' `.' y^ � •w».,du....1.'e+ $.9 •ro ~EPR X1rM SA -1zW454AN•ppt,eAfA.7: • zu ^ A•' • • cqVOA ,'.. 1 „A., q_ °°4.AaR, w °' a. go —4 . 0-29..tio A.p.o Aw .^, ' ^ ,tp.0 P.0 B wp•F O e,'P0" A y .. A N r 1 �C A •w p '• �.1' (.''1 d+1. i ._. 1 oa w$4 11.8.g 'a !�...• O'd -,.:;1'rvwC,7 pOi !1 •,r8w5r nua0-Eu!1 to 4._ _ .,` ��id} ...II oQ =a.e44sea•aLowao S''' oI a'�o �� ,,,,Aa,yol4w44 © t.ilt " �•gpo,•,,s, ,^x ro5x '»oAw ah;agi'=n wQ. itIN . Wr, .. f� p OA :+ ^ °��e �t Cs.', p� .+.�i A g. .•++.�w•. "''°�y p,a- olio room., a.5• M a °.A .. ,•.L.;. . aMggB ' d "`rlflhftifl:RII y - -•AA £.w �• o » �e, • A " " a o 6�' a"A�+^ Apia wp wf°9 ° lit:g%`...�n gyp p' 9 p• 0..� w•,, •.ro_ .ti .�',. • x.g. _. .... s. a''E s•a p• t�t�lala O o.5ei. .'?..^. ... a..w y2.O A r O y •J q; . p "u• • "-^fie s :•• --z �___ �i 0.4rL g• O p1.p to 0 eye 0.= a•p g - ,,, ,E.��.-, 0. -. 2. ?:..weiNti@L; erg ,. : ._M r i_a .. d, ,iIu, o- A v, owr " A ...w .. ^ G'T O . Ap '• .*i�j .w p 11,2.n* a " O y ^ yp OS', RHik •o a: ab 4" •"" 'MM '� .. .� �'0A 'd9 .n 7. �+:". " " o " .* O2 �S ^ •8 ^ 3 u _ LI •*p ^ n." E . E ..4 ;F ' } A., 0Ac ::::T ?< 2 A •.-'y fbjw' y , pp : �j ►r r 8 o np4, r&•A .pp+9• Go]•.y~*•O"�A •.y ". �;, x` M PE•QP '<▪ " ry A.(^� 0 O A Y9 " O-^m.° ,-"y ° 0 p� ii.1- y+�.2^c, Fk" 74 •^i 6 4.w 0�- =— ,••L o FJ 1 Z :..i ; . f{i• p' y ri •= 0.p •A4 y M'r7 rl e•.'wt O p1—O 246 .-'- (p�� �Q}> - i.y .*`.'^ ff •TG p.•C A p uw .p+ -'n ��� ,,, <{�Iyl.� " C S•A{7. l a:�. .QO•y� �+ «°1'y ^ eo�0 a` " Cs p. � 0 .°+," W G� AA '•. 0.... `6 o. .k A A. o O era- g " # o•� w ro ro y w A` •5.0 p•A g Ple g a.O p >. . w A x o- al a''8 g E, E '.*g s•' p 0-8... A ..*• p'2, i.^ "v .= g.0 »' o ..�.'1 .. ^0° • "4 rya•.1� 24.-•boa. o p'<'e o k e" ° A . ail G �1��_�pp N+.c �i �i 11 ,y A C...p A nw_41 bg DA s rt. O p•yv ..•p •�pO�C O O to O CI.z�O y ,y p GR .j, Y 6.32. ti O n' E'0.."*Er Cn i w �., N a p A ^ ,." el o r.`0- `5 ,v u « '1 A R .ry O ..." ,O"j,• a. k