Untitled (5) 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.._._4rt...__..........._
5601 Town
Dist. NoCounty warren. Village GlenuA...F.alls...Hospital
or City (If city,give street address)
Name of deceased Baby...B5?Y. .Gx'eextsp xt
Single, married, widowed,
Sex. a4 Color W 1i:t it divorced (write the word) Single Date of Death.,..@.1.4,Ar..y... 19..4a
Age Years... A Months Z Days Birthplace G.iarts-, all--S.r.I1I•...:Y.
Cause of Death An9 aa.;. ate ,,.cta s I t '.i y .,,, ,...._..Cart
ertificate was signed by Barry...A.*...Pecka • M.D.'
Address Glens Falls*. New York .
Place of Burial (or Removal) 4.4.:. .fz . ...Fealz.'...Na....L.
(If body is to be temporarilyhel i fill n space later)
St metery Sara ;I: il° Date of Burial FebXuary....4til, 19 44
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 3' w e'ingleton G,�..e..Xl a..F.4,1.6.
Name) (Address)
the UEdertak� • to hold temporar. and.. I it.--r the body.
(Undertaker or person baying charge of corpse) r,r move, o e f[state how
Dated .'`eb, .iX'y 4.tb. 19...4:3. (Signed) .. ., .. .......
Deputy 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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