Maynard, Minnie Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
CrThis 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 N, 34 3 w_
Town lens Falls Hospital
Dist. No..5.G.Q.l....County ��a.X'Y'.cx?. Village'
or City (If city,give street address)
Name of deceased ill's..... ia.Xm1.a...Maynard
Sex F e ma 1 ��h i t e Single, married, widowed, ;pia�r• ed
dolor or divorced (write the word) Date of Death.T)s.Q.4...2a, 19..39.
Age 56 Years 2J Months 14 Days Birthplace Da.ans..Fa1.1s.,. .N....:/
Cause of Death G3.170.1.1a .pa. .cza ...Ca.e U11:1...y S..
Certificate was signed by -Dr.,.:..,,Jghn .I . She1. .9D M.D.
Address c l e ns ,l l s, Y, , ,
Place of Burial (or Removal).T.taro...i?f....Q.L19AX1S.b.ldry.,...1F.R....i..t
(If body is to be temporarily held,fill in space later)
Cemetery 45: ......A7..p3.1.RX1S].tS....GeLio harry Date of Burial Doc.....27 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 Jo s e„n14...k:.t...BAZAD o.o.s...k:0<1.1.5.,....N......X:,►
(Name) / _ (Address)
the 'J17tds.0 to er to hold temporar ,d e.r.. • the body.
move,- or oar disp
ose or person having charge of corpse) .��� �. of[state how])
Dated Dec , 2 Q., 19.39. (Signed) '4111.
..
Local : guar
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.
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