White, Edward 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 CERTRICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No...l_._._..__.___._.__..
Town
Dist. No 5601 County Warren Village Glens Falls Hospital
or City (If city,give street address)
Name of deceased Edward J, MUM,
Single, married, widowed, Married March 29 9
Sex.M Cotor..Y!►xl.it8.or divoresci (write the word) Date of Death 193
Age Years Months Days Birthplace
Cause Death.eath...Acute ruptured appendicitis 8 days; with general peritonitis 8 da;
8e i tos ed bfailure e } :cute cardiac " 1 da pr.•. 1 . r191fter M.D.
Address Glens Falls NY
Place f Burial (or Removal) Tgwp of Queensbury (West Glens Falls)
(If bod is to por y held,id,fill in spacelater)
Cemetery Bt. Alphonsus Date of Burial April 1 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..I4i4ma1..21a...BQiYif G, o.u.A...rtAll,I
the Undertaker r(Nan* ter (Address)
to hold temporarily and the body.
(Undertaker or person having charge of corpse) (Inter, n o =_� . 1 ,, owI)
Dated lla ell..30. 19.39... (Signed) y. �+ !.r l ar Deputy,
Local Registrar
This Permit is suff'-ient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regu..ions),unless rerneoal is by common carrier,in which case a Transit Permit (VS No. 62) is required.
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