Miner, Louise Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
• Car 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._1 ___.-___..--_
Town
Dist. No..5G..Ql county...) rreA Village 18 Orville 8t,,.Glens fallss...N... Y
or City (If city,give street address)
Name of deceased Lon tie...minor
Single, married, widowed,
Sex....F@m ,C9blor wh4te or divorced (write the word) widowed Date of Death Jan. 18, 19 39
Age 76 Years 2 Months a Days Birthplace Day Center s...N.,...:X'e
Cause of DeathAr.' Qr.Q Sclerosis-1Q yrs.:Chr. Myocardiptis-1O yrs.:ne_phritis—lops .
Certificate was signed_byii?s. '.tAmko?-.1Q_yrs .... Dr. H. A. Bartholomew M.D.
Address G. ..en#... .All.&.s....I e.w.Yar.
Place -.f Burial (or Removal) SI.....Alp I.Rn, I € ...Ce.mi /Zest.. .1.en&. .''.81l. ......T ,....Y..
(If bod;-is to be temporarily held,fill in space later)
Cemetery St.. faUa...C.etll.. Date of Burial J.ai ....21.. 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 carefulexami-
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 Lionel J, Baivin Glens Falls., N. Y.
(Name) (Address)
the Bl dal"t8 e ' to hold tempora 'I Or the body.
(Undtrtaker or person having charge of corpse) I remove rwise dispose of(state how])
Dated i—19— 19.39..- (Signed
Local Registrar
This Permit is suffi,int for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regu:bons),unless remove/is by common carrier,in which case a Transit Permit (VS No. 62) is required,
.
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