Warren, August form vs.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
cr 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. 169
Town Dist. No5601 County WGlens Falls Hospital
�e Village
or City (If city,give street address)
Name of deceased August. Warren.
Single, married, widowed,
Sex lQ.Color...W 1.:t9or divorc :l (write the word) single Date of Death June 11 1939
Age 4 Years 1 Months L8 Days Birthplace Finland
Cause of Death Ge7ter 1,...EeritoT t .$-4 days:Rupture transverse colon-struck by
Certificate was signed by.P4Yie handle at work in woods-4 days Dr. L,. J. Butler M.D.
Address GlQns Falls, N, Yt
Place :,f Burial (or Removal) TRIP....4' Q.114011sbu7y,, N,,„Y,t
(If body is to be temporarily held]fill ins ace later)
Cemetery ),e YI.�W..cAiq.@1: 4 '.Y Date of Burial June 14 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 Jaseph...F.......T glut Glom..F.Q.1113.4 Nt.X*
mnftee) (Address)
the.rindtrteker to hold tempora nte1 the body.
(Undertaker or person having clivvgml corpse) move dispose of[state howl)
Dated.....4-i e 13 s 19 0V (Signed)... ... . ...
Local Registrar
This Permit is suR',-.:ient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regu._ ions),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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