Truesdale, Seth Form VS M. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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.._'kJ-_....._.- _.._
Dist. No 5726 County Washington Hudson Falls, N. Y.
�x (If city,give street address)
Name of deceasectleth P. Truesdale
Male white Single, married, widowed, Widowed
Sex Color or divorced (write the word) Date of DeathAtuBt 23, 19 43
Age 81 Years 11 Months 29 Days Birthplace Bolton, N.Y.Warren coy,
Cause of Death (18.13tix'lC,.. esior 'Iilge - GaX.'Qr.S14Pa...9....e041e,0
Certificate was signed by G 9 g6..L Ca .CY - ----. -M.D.
Address H1d$Op Falls, N, Y.
Place of Burial (or Removal) Q1ueensbury,, Warren County, N. Y,
(If body is to be t u r ld!14 11 eeme
Cemetery S` y Date of Burial August 2?s
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 dy they basis thereof I HEREBY GRANT A PERMIT p �j �/
to" 11 .Uarleten fluslo.n...}L.a ll.s.w...NA....Jr.w
(Name) (Address)
the. Under, 't l' to hold temporar' y and In the body.
(Undertaker or person having charge of corpse) (Inter, ov se dispose of[state how])
Dated Auauft 404 194a3.... (Signed)
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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