Wells, George I rn, j 61. '7 NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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 D ABLE BLACK INK. Registered No. A r
Dist. No.0..��Q/...County... .... sue/ V tage.. "all-e, l
�r Cltr�� � (If city, give street a dress)
Name of deceased � �j/�if' �fs►�,, i_
`� Single, ried, widowed, *y,,
Sex. - . Colorer. .... . .or divorced (write the word)....Ate- 4.1 Date of D t ...2.1i1li..../ .iii 105
Age o`J...4 gars / ntli 44 Days, B. thplace._.. . ... . .yT. . .,..,,.... ... .
Cause of Death . .... i �� ./.r.�..f!,.... .... .... ....
... ..
Certificate was sinned by
Address •. zele-ir •CA'.
Place of Burial (or Removal)..,/.-�x• ad.a.,. , -,,
(If body is to/�empora ll he , till In sp c later) J
Cemetery5� �.. �Glrltl ' '✓�
- '(� ate of Burial./���� G 1.9� 19..T•+�
(If body la to be temporarily held. fill in apace 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 ac pted the same for r ' ration, have recorded it in my Local Record with t above statue_Registered
Number and on the s' eo EBY GRANT A PERMIT � / ,��``� t
the to hold temporarillp�an .., th dy.
( , ertaker or per n having charge of corpse) n ov or Nth wiyg�d Spo tate how
Dated .l% 19 0—.. (Signed) C'
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subjec to loca
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is requ ed.
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Form VS 67.
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER ' S REQUEST TO DISINTER BODY
1' See Special Administrative Regulation 1, subdivision 4, Relating to the Trans-
portation of Dead bodies by Common Carriers, as printed on the back of TRANSIT
LABEL.
N. B. Permission for disinterment must ALWAYS be obtained whether the Body
disinterred is to be transported by Common Carrier or by other means.
I HEREBY REQUEST PERMISSION TO DISINTER the dead body of
George ells , who died in the* :as Falls
(City, Vane, 'Fawn)
of 'barre n C o•nt y on* rc h 1 Jt h,1945 , Sex mal e
Color or race* wb.it e , Age* 56 years, and Cause of Death* joronary Thrombosis
NOW INTERRED IN.� -r
(a) The body is to be TRANSPORTED BY COMMON CARRIER for
ry
at rlen , Falls Cemetery
(State fully the disposition to be made of body) (Name of place or cemetery)
(b) The body is NOT to be transported by Common Carrier but is to be
at Gl ens Falls T!.Y.
(State fully the disposition to be made of body) (Name of place or cemetery)
(Signature of undertaker) �.�,,c'.(,<1 � / Oert.a
Dated " " T 5tf` 19 y5 Addres34 -urren St. ,Glens Falls ," Y.
License No. 1338
APPROVAL OF HEALTH OFFICER
Dist. No.
I HEREBY APPROVE above Reques and ecomm ermis on nted.
(Sig lure of He Ith Officer)
Dated _� l
Instructions to Local Registrar: Fill out (a) Tra _permit for bodies trans-
ported by Common Carrier or (b) ordinary Offical Burial (or emoval) Permit for bodies
not to be so transported, in each case writing the word"DISINTERMENT"on the Permit.
The data required concerning the decedent may be filled in from the local register or
cemetery record. When data can not be obtained write "Unknown" in spaces in-
dicated by (*).
The Disinterment blank should be filed and carefully preserved in your office.