Burnett, Mary # r 4
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
W 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....5.6Q1,..County Warren Village 5 Bacon St. , Glens Falls„ N. Y.
or City (If city,give street address)
Name of deceased Nary Et Burnett
Single, married, widowed,
Sex. '.g.Rl#. 0Color.Jhi to or divorced (write the word) Widowed Date of D ath March 23t 19 39
Age 84..Years it Months 26 Days Birthplace Diamond Points N. Y.
Cause of Death...Qaxabra.1....AI?apL.e.Xy ; S mility
Certificate was signed by J, W. Stevens M.D.
Address Glens Falls,. N. Y.
Place .f Burial (or Removal) Town of Wueensbury, N. Y.
(If bod;'is to be temporarily held,fill in space later)
Cemetery 2.3..i a .VI.i.I.. .Q.em t.Qr,y..}T,$wlt Date of Burial March 26,, 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 Harald...C....S: att.ord 24X G ;o. ..A.t.t.►....Q1siti ... ' ?:.ot
(Napthe Lamle tuc.e�P to hold temporari i( '+4V) the body.
allertaker or person having charge f corpse) remov oth se dispose of[state how])
Dated march 25 a 19 39 (Signed)...
Local egistrar
This Permit is suff cient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regu.. dons),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
o`�n �,„ 0 p r s. s.S K �.cn c r,, °�b ?:o,o,� 2• r"Q r4 0-0 n ,4•� 1 < n c-55•a:3 '"' 'E C7"••It• •....
e =* t~a ~ � w � a + � Hro o -� x� -�`< 't0y.=•`=-•eo = — b ,-, a0 ae � `��� 0 Pi
:,Y9 ro3 ., ttr, Hco,c env ^ roWcm •,o tiro roaiii
! iIJ;tn
ticom• En • p'C1 W O I
A 4. Na i.a
.• .0 •y o ro ry a.,,, o a.� ro ... m e
* oO.N .10 .c -., 5, B ov
g f°w *x° eyv� .0-a;w�r`-'-*UU ("( < ` rokRey
^t ,• O_O O,-. ti, .. f. CD .. , o, =.0.. ro n .�• n
O O •Ctj A7a?` 5. fgR0,"� F4 .0 `lijIuL
, S � a9flE
nF+ � �:•'�Tn1�gti'�n�-`•PrCO•uO�o � f� rw,O .y,.,.��T ./yw��'1
M. o a. ra.o-<'ti A n 0...., o Pa�•�e0i,- a.., • t N 5, :2Q M •,•„ .+• . - ^' 't tt**��p y O yy 3 e it64ciN
Fr
ell
°a r. w wA g aoo:8 o.O C Cr... ,. .e ;» r w a O N•�s O R' ?^^ r'-, n w O c.w 54 CA ""� Eo9 2 _ AyH
'�1ax � o " nt� E '4oz onoo " oo a e• c v �•
,� ,st'.is••a rt o 2..s• t, -' ., ., a.tp a ...'O• n G '.' ; - E.w ,'r 2.O L1 g (/�
16 X'Q C�rJ! "� 0., A O ...."q ro .J O 0 .`-i.*ro .•.n-- -- .. o h w ro n -,C'n•6'.�.'.n•O •.•...171 epee O n
O nwotiEv = .10,0 , ., -, CD V "I o nn =n •� S ! ►Oy(/I
Cy�'.yA ,...CO ?•- Oro0 , .1 u wCOr�� wnK• P> r, p n0..• a ,.'0ni�ro0t4 Rr1 �• * 1.1 •�e.
a = Sri ro .� 0 ,.,•v . ❑ ?:n o w p ^ 5 ro * 7 ro y " ^ o o K p y a a M
a. C a., a,.� 5'.. .^g a � n .`'..t., " ooaroroot., °� o "' '"b �- 5 � ti iPi.i m C
e tax .,. y " 5- 0 -i n ro n c•n n ^ . a a o+7 • psi 6" , I I.. p�"I
: 4y ,�.eo � .A� tp0ro ., 011g5 o•a �aa ""v'A..., "',.. o T �':-..'2 o " -t F 9 -RP a
C<w i1Q1t
`1.5•.07 • trj
L CG � 190�• a rc'`37, '+ L• o- r' r ' - , = ,b,''' p fl P. n ° W O
`C Cy7; -.=,'" o s.w_ w o ro v O 5 - c. n r'n . a:`� a rt o•""> m :IL p e~i ; �y
C .Z'iD Hill
Cli• Er •...w`5••-1 g.': ro r r .o • - ..., ^ro , C G p a m �.' WO
, 401% 5 — a•o.0 G t•, w °-.'03 a'r b -s � .,. < , - - _ r, n p 0-g p.. -O �•�. p
O.��a e''p '.w �g.'., R'7C .. g , A C 'A s n .q,v m LOj A y M .rtj
m ^ro, ~ n'� 51 •-, , y •5 t . .. .oron w,I • pa ts1Cr157.
I' 0p 'EKwroro W.O ., .0 `c LT^ G.w $-3r.t it. �. ti
O� .► w ro ti n.0 0 sa O:«: • O•� n o .� � - ✓ ,�,, - s•m'R.v" G,.�.,��.0 N "I 2
i 3o `oro o a 'b ro y• r2.
s • e O a O", o "°n ;a 7 ?' r y=,,.. '" a O ''7. w O,. W O .5' •o4 y
. 0 .4 • v ayy 4I. 0* .r.. w � � . ro �SS? xro Q A
•
L►0.."'., O .•• q r! rn �9 0 0F. C , C "' ,Ey '-"•E rt ,C., p.ro�d r 'Z•O.* �'� - O
�pZr p.g °W.Eo �"O" .' � . ro j ' o ..I"R
� '_•o . ,`G = * a ,
o D w .. .n• +.. : r ry0 � 10 � e CI
4. R :ng7 ::•wuw •ti ay., .-•.= +•� '' ,u n 6.� n•'yw R CIrw ' ro .oro ~% vwa 'a y0.cyovro ?o " c . .... PeC~ mCi7a 10zrCS• » S.< o g ~ w a $ y � n ~ 2. = •ow » gov tno2
ao `' rqt .wE `, ,Q'" m axy• . h O• yp v O ^—c � 00 P,••.v ,. ri •0 , • ^ di.
..0, emo *G3. n • .: a _ o "' Ad 0
Rp. 5' •AinWB0... .q ; » = o5'ov °ep5.?.wc.n'w4wS•o . a2.r° A5r
's1
r