Seigal, Jacob corm VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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.
Glens
t Souh Street
Town
Dist. No560-i- County Warren Village 76Falls iV5
or City (If city, give street address)
Name of deceased Jacob Seigal
Single, married, widowed,
Sex I;1 Color WhLt%r divorced (write the word) Married Date of Death...D.P.e. t .Q'X...a.......19..4z.
Age 74 Years 1 Months 21 Days Birthplace Russia
Cause of Death CQ '.Q' xy Tbx'RmbQs.i.S 1 dA.; .Br.QAQ.b.i.tia... ...G y.S
Certificate was signed by Milton J, Greenberg _ M.D.
Address 1-114..$Q Fa:US NY . . _ qr-
Place of Burial (or Removal) Town of Queenabury Warren County, NY
(If body is to b temporarily held fill in space later)
Cemetery Sara Tefilo Date of Burial December 9th 19.43.
(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
to LQreA..TA...Slagle/cm Glens..,Ea) 5.4...Ne34...York
Und �' t(Name) (Address)
the 4' ..ti4} e.r to hold temporar • and Inter the body.
(Undertaker or person having charge of corpse) ter rmove,or is�_d�to how])
Dated. ..,I}.e mber...9 th 19..43. (Signed) +..I ,r ax
Iepu y Local Registrar
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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