Fletcher, Vinnie 7 D 4- -
Form VS.8L
NEW YORK STATE DEPARTMENT OF HEALTH I �--
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 RABLE BLACK INK. Regist No.
Dist. NolCounty ...,,rlL Village, —� .�! ....i‘j.4_17 r
- r (If city,give street address)
Name of deceased Y flnni.4 ityrtly F 4 ioYer ,
Sex.Fe*a.'L*Colonkit�a .i' ;i�(wr'it a word) M4rri*d Date of Death AIAVA Bt.,1Pi 19..”.
Age 6.3 Years 4 Months 13 Days Birthplace....Aralla.,....NwtW..I1lt
Cause of Death 0.anito IN.o.fogar
Certificate was signed by Dra...Barry Depart M.D.
Address Q141116 Foillisa New York.
Place of Burial (o. �' ! ,F ' ) Pimi..Xi, it Come�tzlrj t Gletlls FillleA N.Y.
(If body is to be tempo a .,All in space later) .
Cemetery P1us...Vi.ew.., Date of Burial August,* 22. 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 Orrin* 1t>:...001.1.1nm South Glens Falls, New York
(Name) I ter("dress)Undlart .*r to hold tempo rily and (eddre.$) the body.
(Undertaker or person having charge of corpse) (Inter,re or o se di of how])
Dated Autguat it...P.l.. 1939 t. (Signed). .... ..
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the (subject to local
cemetery or other regu.,tions),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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