Nailor, John Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
vr 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....140__..._...___.
Town Glens Falls Hospital
Dist. No...5.6.R1...County Y ax.rela Villa e
or City (If city,give street address)
Name of deceased John J. Nailor
Single, married, widowed
Sex Ma .e Color White or divorc:.d (wite the word) Single Date of Death I$aY 10 19 39
Age...2.5 Years 6 Month 9 Days Birthplace Canada
Cause of Death Chronic rheumatic heart disease 4 yrs; acute card'itis"'2 mos.
Certificate was signed by- Dr. J. R. Juster - M.D.
.4 ddress Glens Falls ; N. Y.
Place ,f Burial (or Removal) Town of Queensbury, N.Y.
(If hod.-is to be temporarily held,fill in spacelater
Cemetery StA Alphonsus emetery Date of Burial May 13th, 19..Z9
(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, d on the basis thereof I HEREBY GRANT A PER MI
T
to 111 Carleton udson Falls NY
Undertaker"gan`°) Inter (Address)
the to hold tempora •' d the body.
(Undertaker or person having charge of corpse) ,remo ,or (state IIo )
Dated May...12 19..!'3.9. (Signed)
Deputy Local Registrar
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 mu.. ions),unless removal it by common carrier,in which case a Transit Permit (VS No. 62) is required.
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