Gray, Charles Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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........_.____.__._..___
Town
Dist. No 5601 County Warren r e n Village Glens Falls
or City (If city,give street address)
Name of deceased Charles H. Gray
Single, married, widowed, ca
Sex ''ern le Color white or divorc.d (write the word) divorced Date April , 1939
Age... .8 Years a Months 0 Days Birthplace da e y, my.
Y'.
Cause of Death .chronic....caxcl.i.Q...:il:rasgl . EZ...di.sea,se
Certificate was signed by liar.r.y...De.Paan M.D.
A (ddress l e ns Falls, N.Y.Y. 4
Place ,f Burial (or Removal) Glens Falls , N.Y.
Y.
(If bode is to be temporarily held,fill in space later)
Cemetery Eixi.e•.Vi•ew Date of Burial April nth 19..,.9.
(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 Harold C. Stafford Glens Falls , N.Y.
the Undertake�aD18) to hold tempora nd Inty$d_�88) the body.
(Undertaker or person having charge of corpse) r, o ,or ot '� die howl)
Dated. (Undertaker
.i.. e t.h. 19 Z9 (Signed)
epu y Local Registrar
This Permit is sufr;cient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other sego.. lions),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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