Taylor, Henry Foam VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Vir 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, 221
5s01 Town
Dist. No County....MkIr"Qr1 Vill e11...Columhia Avar
ag .. ,.G1.e27m••.ra1,l$Y•1+t.Y•e
or City (If city,give street address)
Name of deceased Henry Gir...TAAStas
Single, married, widowed,
Sex Yale Color whit,.divorced (write the word) Marrleti, Date of Death....AUZ.....a. 19...39
Age 73 Years 9 Months 3 Days Birthplace...Hudson..jR`alLey.... .....y.,.
Cause of Death..G.Q.r.Qraty....0.c.clus.ion: her.a,yamarditia-nnknown:Art,erie.•.«tel,ar•o•aie-Unknow
Certificate was signed byDr-,�...$,,. w.-:.Bair lm ;_- — --- -- — --- 3V
Glens.
Address ...F>:1,�.�.a,..N....I.
Place of Burial (or Removal) /e t...Glaus..F.. 12,.,.N...,Y..
(If body is to be temporarily held,fill in space later
Cemetery. j • A ,pflOf51,S C.M.O.tifit.r7 Date of Burial Aug.. 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 S• T. P¢t#•!tr Gi.ens...Fa1,I8 ....N,...Ye(Name) Address
the Vf filrtaker to hold temporar., t1:•"i'„% fa,, r the body.
^�
(Undertaker or person havini charge of corpse) !�sil re ore ,r j . se dispose of[state how])
Dated E.l... Q s...29 9.19 (Signed)... ... ..
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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