Ploof Jr, Edward Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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. 41
Town
Dist. Nos. Ql County-Warren. Village....glens. Falls N.Y..
or City (If city,give street address)
Name of deceased Edward Earl.n.,,Picot,,., Jr.
M Single, married, widowed,
Sex , Color W or divorced (write the word) Single Date of Death I'.Qb.a...2! 19 40
Age.. Years 8 Months 13 Days Birthplace Verggens Vt, -
Cause of Death Shook and Suffocation 1 day
Certificate was signed by M. R. Frasier M.I?. M.D
Address Glens Falls N.Y
Place of Burial (or Removal) West Glens Falls L Y.
(If body is to be temporarily held,fill in space later)
Cemetery S.t.r•.-A1 .pF1 3 eu ..4`,�em Date of Burial...M& 'C.h.•.1 19....40
(-If body is to be temporarily he 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
to Loren W. Singleton Glens F4jj "AL,
UIIdertRksaving
Name) (Address)
the to hold temporarily a ..,n�l Znter ... the body.
(Undertaker or charge of corpse) �' y6 ter,remov oL (")..... .it ate howl)
Dated 19 (Signed) S .i •
Local eats
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to Iocal
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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