Decker, Louis / / 9.3
Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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._.. ,-
Dist. N;,:. . 2 ounty W.ar exi Town Glens Falls,Village lit Xa
or City (If city,give street address)
Name of deceased Loui? K. DecILPr
Single, married, widowed,
it
Sex Male Color White or divorced (write the word) Widowed Date of Death...F..Qb.•.......7..tk1 19..3.9.
Age $Q Years 8 Months 7 Days Birthplace �.'�'. ftQXl.,....L...$a
..
Cause of DeathCarc oma, of the prostate(1.C..,Xr. .).; T ;i.Kla y j,n,eGt.7.RXl.(.Z... x'.s.)
Certificate was signed byfessr S. Parker M. _IL :Arteriosclerosis general(l0 yrs pigsaddress 1A. Glens Streets Glens Falls, N. Y.
Place .f Burial (or Removal) Town of Queensburyt.1j. . ..
(If hod:-is to temporarily held,fill in space later)
Cemetery r'ineview Cemetery Date of Burial Feb . 9, 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 $. T. Potter 0.1.e.n.s...Fa.7.3..s.,.... d»...Y.
(Name) (Address)
the UndertQ,kQ to hold tempora ' y and inter the body.
(Undertaker or person having charity of corpse) (In ov�e, erwise di to howl)
Dated Feb . , 19a9 (Signed) • tx/Local Registrar
This Permit is sufriicient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other raga. dons),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required,
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