Rightmire, Ida NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sit-This Permit can be signed only by the Local Registrar( ty or Subre i )of the Primary Re�a-
RE District[TMLTdoEHIB the COIL.
RECT AND COMPLETE CRTIFICAT OF DEATH, WRTPEEN IN DURABLE INK
Dist No 580I __..._ Registered No..._.
County W O r r li ____._.__...... s_ pate of Death GQ�e -
'r ,t -of Glens Falls, N. Ye ..��,
..�..._.... ......... C/• Ase-- --9--....Yrs. color
1 or ityr - a l�m)
of city.give street •
•
Cause of Death......... . _ -
Place of (or Removal).. -.• _. _...
(/
Cemeteryy .L e44 i_
e . _.Date O BuriaLj �•S/..Ig.../ `
V
Certificate of Death of...4..... - - - --
(Give full i
having been presented to me containing the abo stated parliculars and after careful esa u"°*ion
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I have accepted the same or registration,have recorded it in my Local Record with
the a sta •Aiiv% to .;it.,and on the l reof I H7aMi.:k PERMIT
to. �.. & -- ...,
/I' �di/r ," „ to - 1 .j:/ the
Dated.. 44.0 Persorhav!aB c1a 9.i ) (A „,* .._ We WU
�-�TJ J, +� di Registrar .....
Permit is sufficient for the Removal (and In •, •at crania ) of a body to any par!of the
State (subject to local cemetery or other regulations),suave* . . is by ,nmen carries,in which case a
Transit Permit(VS No.62)is required.
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