Hartman, Edwin Form VS.81. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar This Permit can be signed only by the Local Registrar (Depu' r subregisirar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF1LCATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No....._.__44_....._........._
- - arren Town Glens Falls Hosr�ital Glens Fal1sN
Dist. No; ...County Village
Edwin Hartman or City (If city,give street address)
Name of deceased
Sex it Color W SSi gle, married' , widowed, Single March 3 40
_ced (write the word) Date ofL�Death i 19
73x: + la Town o ... ueensburx
AgeYearsM eroli -fi 86 M�tion— Chronic m Cjo$i'di't s
Cause of Certificatenwasl signed by L' ari ..�'� itzgerald,E, M.D.
..
Address 191" eng"'Street' Grells ails,
Place of Burial (or Removal) es lens i''all , N"Y
e is to be temporarily'ulens falls Cemetery*. March 5, 1940
Cemetery Y..:,. Date of Burial 19
(If body Is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated partic having been presented to me, after careful exami-
nation, the same appearing to be COM TE, CORR D SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registrat ve record my Local Record with the above stated Registered
Nu nithe a thereof I H BY GRA RMIT '' -•
to evrar� Iasi: gflens Falls, ew York
Undertaken ame) Inter(Address)
the to hold temporarily a.1,10 the body.
(Undertaker or person having charge corpse) a nter, se dispose state how])
Dated March 19 4u (Signed)
• Local egls
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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