Ward, Myron Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
air This Permit can be signed only by the Local Registrar (Deputy or subr.gistrar) 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.
negiatered No..._..354 ,..._
Town
Dist. No..J. ..Q.....County '.7arren Village Glens Faller NtY,
or City (If city,give street address)
Name of deceased M.17.Q.D...I)...:l :l".cl
Ivies 1 y�, i e Single, married, widowed,
Sex a Color or divorced (write the word) Married Date of Death January 11, 194o
Age 57 Years 4 Months 22 Days Birthplace Berlin New York
Cause of Death Subacute Bacterial
`ll'rIE4doro�lyd'itis 6So .4days
--create was signed by Ir va- c 1 : P MD:
Address Glans...E.alla .JJI..Y..
Place of Burial (or Removal) : as.t...Gleas..Falls. . :V...Y.
(If body is to be temporarily held,fill in space later)
Cemetery S:.A 1.P.b.Q.l:Is1-t Date of Burial $7.4.11A ..1..2tb. 194.0...
(If body 1s 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 Lionel J. Bovin 2i Grove Ave, Glens Falls NAY,.
Undertaker(Name) Inter (Address)
the to hold temporarily and the body.
(Undertaker or person having charge of corpse) �,�/ ante , � s�,,p otherwise dispose of(state how])
Dated sTaX1.. a.3 19..4D.. (Signed) X1l� V/.t.
Loceastrar
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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