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O'Leary, Marlene Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT to 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. ) Dist. No 5601 County Warren Vown illage Glens Falls Hospital, Glens F� l] or City (If city,give street address) Name of deceased Marlene Ann 0'Le wry F ,,, Single, married, widowed, i n 1 e iv a r e h ?9 40 Sex Color " or divorced (write the word) Date of Death x 19 Age Years Months 19 Days Birthplace Gi llo... 'a1.1.s,... ':.Y Cause of Death Prematurity-under 7 months gestation 19 days Certificate was signed by Edsall D. 2. EJ 11 Ott T M D• Address Glef�s �9I) s, Me47 r' °'- St. hlrhonsus cemetery,T©wn of_ queens-burv, ' Place of Burial (or Removal) s (If body is to be temporarily tea:fillktnl le s Cemetery Marc? o0, 1940 Cemetery Date of Burial (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 8 A ;a r re n Street lens nn F l l s to Seward T F4tter ) a , TTndertaker (Name) Inte (Address) the to hold temporarily ate- the body. (Undertaker or person having charge of corpse) / nter,rem dispose of[state how]) Dated.... s x:C.b... Q0 19.4.0... (Signed) Alb . ... .oc Regis 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. I. or xti � ti cA.feA<� z eo ..Kw 'gip 5.+ ° ndOnW a omoO •+ Cr >• M zA.4 a^ g` o a t~ a.,, i..1.2'„0 = a.'z•n n `wog.0.V,W a < .:�i aC', g ? p N NOan "EAF �•., e I I O Z 'A • p '.eo ^ a'`J.ap � :e 56310 0 .,, or5.owaingeeItwN6Rw,0 eCe. �x4a to s0ZZ, ; 0 0 A "7..0to mecoo4•< gee0c<.sw ° co. wpeppae...i^ -, O GO _ n0-. . to ., ,w+0p� aN'V ia, �w pp • " O a -,• pp. .eo00p.., ., a mapfR w7..�o .°. 0e.y a. O X p a,m 4,0 ,,"p.0 m'p m 0"t D 0 We•p»••to O g•a..n< a ,. ° re P3. g° • �►,w ' �v .. e, to o,.t° 0, .. co N , p � ffee £ a s ' e"e R,�yye• A��1 Gip \ fi//1� •e ,.4C..] 'Ottoe' a= t*Oamc)relt'�o ". 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