Stanley, Hiram Form VS.6L 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.._...._.5 7 ......._—
Town
Dist. No..5.62 Q.1.....County... 5efl Village G1ens•••Fa11a..N..Y...
or City (If city,give street address)
Name of deceased Hiram A. Stanley
Single, married,widowed,
Sex M Color W or divorced (write the word) Married Date of Death X.a...l6th..19..40
Age 51 rs....... .0 Wills
10 Da Birth lace Luzerne NJ.
Cause of Death ral �nsuf icenc r Day
Vascularb Disease
Certificate was signed by arr�T De an M.D.
Address Glens...F.alla•••DI.M.
Place of Burial (or Removal) Wesh...Glans.•.Fal1s. N.Y..
(If body is to be temporarily held,fill ins ace later)
Cemetery St s AJ.V1Qn3Js....Q xn.• Date of Burial Mar......1•9th 19.•44
(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 d o the basis thereof I HEREBY GRANT A PERMIT �T V
to Lionel J. Boivin Mans Falls •7 a.i+...
Undertaker. (Name) Inter (Address)
•the to hold temporarily and" the body.
(Undertaker or on having charge f corpse) remove,o 0 of[states ow])
Dated 'ar th 1940 (Signed)
Local lie strar
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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