Lambert, Evelyn Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
_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 CERTIklgATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered Nos._..__.._2.._.._.........
No5601Warren Town 90 u
Dist. County Village `�9....till... .t4'.ors•.•algus•••Ed,lls.+...N...Y
or City (If city,give street address)
Name of deceased Evelyn Lambert
Single, married, widowed,
''Sex Color white or divorced (write the word) widowed Date of Death MOT 25, 19 40
Age 75 Years 8 Months 29 Days Birthplace Ste Sebc.stien Pq Canadc
Cause of Death CQ.r. .1. '$l.igN P.r.h... . .;+ 1gm'gIg,'. y] gduag .. . .b.r.4.rkra te.r.7..0
Certificate was signed by....FlQyd palmer „ M.D.
Address Glens rails, 11 I`
Place of Burial (or Removal) !Nat Crlens Falls, N y
(If body is to be temporarily hold,fill in spacelater)
Cemetery St, 41phonsus emetery Date of Burial.. &Y 28 194&.•
(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 A,i9np1 J,•. A4ivin Qlens Falls s... 1..X
(Name) (Address)
the UnclertaXer to hold temporarily and.. Inta the body.
(Undertaker {.person having charge o1ggrpse) ter,re ve, of pose o![ w])
Dated may //g 19 UU (Signed). f �.( .• .
Local Registr
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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