Blondin, Louis Form vs.ea. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICLAL BURIAL (OR REMOVAL) PERMIT
tw 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.
Town
Dist. No County...Washington Village i .x.t.r.ozd.
or City (If city,give street address)
Name of deceased l..Q?.1is j, Bl and in
l e Single, married, widowed, .
Sex Color....WI i.teor divorced (write the word) Widower Date of Death....,Lu.a.y...2 1945
Age 64 Years. 5 Months z0 Days Birthplace Canada
Cause of Death chronic Glameralonephritis Gnronig lIy..Q ,x: .it.i.s
Certificate was signed by Dr...,.... igz).ued. Weirs M.D.
Address F, E-., Hudson ' Falls New York
Place of Burial (or Removal) Town of cueensbury Warren Co , N SV.
(If body is to be temporarily held,fill in space later)
Cemetery St._....!'-..:.Cli1ot^,.sus. Date of Burial July .5 19 45
(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 - �:_
Rogers p- Carleton Inc huUson Falls "c. York
- T�i _ + (Name) (Address)
the i to hold temporarily an Ini,e..r the.body.
(Undertaker or person having charge of corpse) (Inter,remove,o other ise dispose of[s to how])
J.Dated zig, 4 19 6.5 (Signed) 7
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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