Glenn, John NEW YORK STATE DEPARTMENT OF HEALTH ) r
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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, LEGIBL WRITTEN IN DURABLE BLACK INK.
Dist. No.3l4r6 Registered No....
» Town
County. ..». Saratoga µ W village oreaLl...»..».. .......»
or City (If city, give street address)
Name of deceased John Glenn
µ Single, married, widowed,
Sex. 8 „Color W .ite or divorced (write the word) married Date of Death......... ... » »»....19 40.
Age. Years.......... Months ... Days Birthplace Hudson Falls N. Y.
Cause of Death Ca.P.Q. .n,Ql1 a of $t.oulaQ.11
Certificate was signed by...,..RQ.Y 11. Borrowman, M. Pear....._.._....... .. » ... »..»»». W. . ..._ _..�..M » M D.
Address Fort Edward, N. Y. ».»_... . w.
Place of Burial (or Removal) ,dine View Cemetery
(If body is to be temporarily held, fill in space later)
Cemetery Date of Burial....Ti3nua.ry
(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 examina-
tion, 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 at.O.Wftrt 1Qtter 84 Warren St. , Glens Fallss._ N. Y.
(Name)
the I7ndcrtaker ... to hold temporaryand.. Inter (Address)
the body.
(Undertaker or person having charge of corpse) move, o se dispose of [state how])
Dated. �...r 11 tll h 'Y 19... P (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), s,nkss removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
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