St Clair, Richard Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t4 This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Pr.Z.,,nry 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.. 251
Town
Dist. No...5. .Q.I...County warren. village 01.Ano .F411.o .1.1.Q.gp.i.tal
or City (If city,give street address)
Name of deceased Ri.chAr.d.At...Glair
Single, married, widowed,
Sex Male Color white or divorced (write the word) Single Date of Death September 13i9 39
Age -- Years —--- Months 8 Hrs .parr Birthplace GLOXI8. .F.041.1.8.,.. .N.• .Y.A
Cause of Death ily.dreardo.A..1 .PrAintxtrA 14.1.rth-1 d4Y
Certificate was signed by .D.r.....13..... .G.A...T.17.1.QtAki M.D.
Address Zor.t .Edward.s...11A. Y..
Place of Burial (or Removal) fiumzik.ury.s. .N... ..r.,
(If body is to be temporarily held,fill in space later)
Cemetery EiXIQ ViSm. Q.P.1110.terX Date of Burial Sept. 12a 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
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to 14PM]. .sT, 1301Viri Glens Falls, N. Y.
(Nam e) (Address)
the Undertaker to hold tempora ' Inter the body.
(Undertaker or perion having charge of corpse) cove,or o spose of[state how])
Dated Sep ., 12 19 .3.9. (Signed)
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.
so.
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