Lynch, Frances Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
121/- 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 01
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered Nam,_.,_289_ .
Dist. No 5601 County Marren lawn 4i Monteala Street, Glens Palle
or City (If city,give street address)
Name of deceased Frances E. Lynch
�, Single, married, widowed, Si le October 29
Sex Color or divorced (write the word) Date of Death 19
Age 27 Years 3 Months 4 Days Birthplace Ga.ftnA.. '.a,.3.a.>a
Cause of Death 3uba¢ut4 Bi ts.tariel..Ensi ?amd .tr.►is-a.a,..A0.R.s.. ....arhr..BhatilR8.t1o...hekirt...d1s
Certificate was signed by 5 Y. • :AC tAMP.. ?II r .. Mal 1 .t:4... ,DZ.J.alis,iufitrarD
Address Glens .Falls„ Na Y,
Place of Burial (or Removal),..T.own...o.f..quee 38bury.,...N..•••Y,.
(If body is to be temporarily held,fill in space later)
3Cemetery 4....A1phonsu.s...Cemet�ery Date of Burial Oct. l 19'S. .
►
(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 Registere<
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to liaZQ1.d...i......$tatfC.rd. Glens Falls-,••-K,Lr
(Name) (Address)
the Ufl taxer .t( hold tempor.; � $1,{, * ,� the body
(Undertaker or person ha n charge of :01811ow:
1 / ,ove or . , se dispose of[state how])
Dated Nit.... al, ''��- ,,. ed).. ,. ..
I"Ii'"' m, r'-
c, '• al Registrar
This Permit is sufficient for the Removal (and Intelsent or Cremation) of a body to any part of the State (subject to lots
cemetery or other regulations),unless removal is by common carrier,in rich case a Transit Permit (VS No. 62) is required.
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