Tait, George Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
szr 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 CERTIFI�CATE OF
�
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. _...._._.._.._
Town
Dist. No..5.6Qa.....County Warr.en Village ��'1.6i...Glen...Stx e.e.t
or City (If city,give street address)
Name of deceased Qeorge Tait
Single, married, widowed,
Sex.Al8.1. Color WbitAr divorced (write the word) I± .Qwaa Date of Death.NQYATO.b.e/* .4.1. 1910...
Age.79 Years 9 Months 1 Days Birthplace...Pick ringe....0n.tariO...ca. a
Cause of Death ...Q Gilo.raa,...of...pro.s.tS.t£:...with...ass.:4L13..metaS:taias
Certificate was signed by ��:.,P.,SQ...►�'t......E 'artg M.D.
Address Glertz...F.a.1,a,.s...NY
Place of Burial (or Removal) P Iowa..mf....Qaie.ensbury
(If body is to bet temporarily held,fill in space later)
Cemetery e View Date of Burial....November...6th 19..4Q
(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 sTGS.Q,Pil. .ER...,floz a G1..en ...Falls...Ny
(Name) (Address)
the IAadertFkcr to hold tempora ' and the body.
Undertaker or person having charge of corpse) ter r move, the se f te )
Dated...ki OVe 4?.u....6 .1 194Q... (Signed) .r.. .... ... ...
u 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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