Bosner, Charles J n
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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...___20...._._
Town
e Glens Falls , Y (31 Coolidge .. v.
Dist. No 5601 County Warren
or City (If city,give street address)
Name of deceased Charles S. BosneT
Single, married, widowed,
Sex X Color W or divorc:id (write the word) Widowed Date of Death rebruary 83..19..0.
Age P. Years .1 Months g4. Days Birth lace Pi t t sbur, ;h. '4a
Cause of Death O.e'e:13a li01 Rrl,#8e-10 days vulnary disease of heagft« yerter4siol
Certificate was signed by CAP.,. A Ctb:014$a M.D.
Address Glens Falls, New York
W
Place. =f Burial (or Removal) TO=,.of Iffueitiabury f New York
Cemetery(I boet is to be tempoPineIdViewpacemeter February1040
Y Date of Burial .t 19
(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 is thereof I HEREBY GRANT A PERMIT
to ewara T. Poer • (liens Falls, New York
the UnderteriV to hold temporarily nn Inter (Address) the body.
(Undertaker or person hams charge f corpse) '�y = Inter,re o e dispose of(mate how])
Dated February 84 19 0 (Signed). ,. 7
Local Rei
This Permit is suf('ieient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other rage.lions),unless removal is by common carrier,in which case a Transit Permit (VS No. 62) is required,
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