Lampson, Richard N
Form VS.61. 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........29 ._...__...
Dist. No 5601 County Warren. Virage Glens... 'a11.s.,...N.....Y..
or City (If city,give street address)
Name of deceased Richard...Sewa d...La pson
Sex Male Color ''hiteor Single,divorced (write ithe widowed,
Single Date of Death Np.Y.x...a 19...40
Age Years Months 5 Days Birthplace....G1sIIs...F.a,1.1s.)....N.j... r i
Cause of Death Erema tur.(....b i.r.thm 7 mO x
Certificate was signed by Dr.......ii. ..A.....Bax�th( .om.ew M.D.
Address--. .Tien S r. .e. , Glen.S..lal.i.S.f...N.. .Y.. -
Place of Burial (or Removal) iltas.t...Gl.etas....E.au.s
(If body is to be tenpniarily held fill in spa later
Cemetery ��est Uilwns Falls Cemetery Date of Burial Nov. i) 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 *worded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to Seward T. Potter 34 warren Street
Undlertaker (Name) Inter (Address)
the to hold temporaril and the body.
ertaker or on having charge of corpse) ve, e
oseo ( bow])
Dated .. 19.$4.0.. (Signed) Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation a bod o any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier,in which case a T ansit Permit (VS No. 62) is required.
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