Lambert, Peter Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ta 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. la
-_..__._.__
5601 .` Warren Town 90 South St. Glens Falls, N Y
Dist. NoCounty Village
or City (If city,give street address)
Name of deceased Peter. ambert
Ia. White Single,married, widowed, j Married April 16, 40
Sex............ or divorced (wri the word) Date of Jleathcn. a .Glgn ,
l
Age Years .' Months Dais Birth lace P �.�. 81E1-t
Cause of Death Cerebral iaemmorhase- mii mitiils a g l:ir&ag�'-arterl:a
Certificate was signed by �i eOY F .d. lime.z W York
Address
Place of Burial (or Removal)
West ens Falls, New York
(If body is to be to r+rilA#etldtti LitliVe Virile April 18 40
Cemetery u3 Date of Burialt 19
(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 th basis thereof I HEREBY GRANT A PERMIT ens ii ells New York
to Lionel J.
(Name) Inter(Address)
the U.nd.ertake.r to hold temporarily and the body.
Wn rjaX p pl,er or on having chargecorpse) .. ./.(inter, ov hgryvise dispose� (state how])
L?r
Dated . ..1 j1 17 a 19 ' (Signed) Q. � �..
Local Re&trar
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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