Varney, Lena Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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-1%3._......
Town
Dist. No...5.0.Q1....County Warren Village 17 New Street
or City (If city,give street address)
Name of deceased Lena Varney
..Single, married, widowed,
Sex f• Color WILL"ordivorrld (write the word) Widowed Date of.D.eath.....April 6 19 39
Age 64 Years 2 Months 21 Days Bir lace Glens 'Fanls, X. 'Y.
Cause of eat ..Q rd de go sensation 1 yr; arterial ypertension ID plus yrs;
Cart icit��was signeedbp'Llsm . = `� Roger S . Mitchell M.D.
Address Glens Falls, N.Y.
Place f Burial (or Removal) Town of Queensbury, N. ' .
(If boy?T Is to be temporarilK held Pine
later)
Cemetery tt'' V 19W Date of Burial April 10 19 39
(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
Nu and on_the_basis thereof I HEREBY GRANT A PERMIT
to onel J. Boiyin Glens Falls3 11, I,
Undertaker (Name) Inter (Address)
the to hold tempora • and the body.
(Undpriaker or person having charg keorpse) ter,re ve,o e of[eta howl)
Dated p 1 t,b 19 (Signed) ��33
Local Registrar
This Permit is sufr^ient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other rev...-tions),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required,
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