O'Neil, Martha Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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 3.46
Dist. No 5601 County Warren Village 78 Park Street
or City (If city,give street address)
Name of deceased Mfg:thek...Q.i.afitil.
Single, married, widowed, December 26 39
Sex feltlf}leColor wh .tP or divorced (write the word) mo.x:r.ie.cl Date of Death 19
Age.Al Years $ Months Q Days Birthplace..i fl
Cause of Death Chronic brogtglatig 1, year;;,,,my gagdial d.egerop,dign. 2 mpg
Certificate was signed by Dr. M. L. Haviland M.D.
Address ulens Fallsa N„ Y,
Place of Burial (or Removal) Town of Sueensbury, N.Y. (West Glens Falls)
(If body is to be temporarily held,Ill in space later)
Cemetery • Alphonsus Date of Burial Atge.1001Z 29 1939...
(If body le 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 Loren W. Singleton Glens ralls,a X,Y,
the Undertaker(Name) to hold tempo and... Inter (Address)
the body.
(Vpdertaker or person having charge !corpse) s , move,or of(state )
Dated vecember 27 19 f39 (Signed)...
a y 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 regulations),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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