Lebrun, Fridolin Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sir 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.Tow ..._..__..___
Dist. No5601 County Warren Village Glens falls Hospital
or City (If city,give street address)
Name of dec4ased Fridolin R Lebrun
r Single, married, widowed, ,
Sex. ia. .Colo'WJ.i.te or divorced (write the wordigarrl.eci Date of DeathMarCh 1$ 1
Age...Z9 ", -` .Years. 7 Months a..fays Birthplace C ndq.,
Cause of Death.' . . . . ..>i .. .rUl f .,..(;, =
Certificatd was Ined by.....Ed.w.azd. 1.t.zge.ro: ..d M.D.
Address Elena r'al.1.a...N..1.
Place of Burial (or Removal) TAwn. . ueen. bury :Lars n...C.a....N...:L.
(If body is to temporarily held,fill in space later)
Cemetery.Z....:A1p.11.40fSJ2S Date of Burial.M :Q 1...2 ' 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 s"axnn: 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 lon"the basis thereof I HEREBY A PERMIT
to.13. gars. &...Qar.le.ton..Inc..(W. /•••• • Utud.s.on. .E alls....N..Y..
' (Name) (Address)
the -Under# w i' to hold tempora ' and ]nt 4 r the dy.
(Undertaker or person having charge of corpse) r,remove,or of}7�p���.��ise disj "e ow )
Dated.I z.Ch..2.1 143 (Signed)....... .... , ^ric✓'••., �// .
Local Registrar
This P rmit is sufficient for the Removal (and Interment or Cremation) o a bod o any part of the State (subject to local
cemetery d' other regulations), unless removal is by common carrier, in which case a ansit Permit (VS No. 62) is required.
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