Lazarus, Tillie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Fir 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.
Town, Village Registered No.
Gloversville
Dist. No. 1701 County Fulton or City
(If city, give street address)
Name of deceased Tillie Lazarus Veteran No
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the word) Widowed..........Date of Death May 5 19 70
Age 78 Years Months Days Birthplace Luthenia
Cause of Death C.er.ebral....Art.erio.s.celerosis
Certificate was signed by ....Mero.l E'-r. Brickner
M.D.
Address Gloversville, New York
Place of Burial (or Removal) West Gilens Falls, N.Y.
(If body is to be temporarily he d, fill ins ace later)
Cemetery .Bharra....Tefl.io... .emet.e.ry Date of Burial May 7 1g0
(If body 1s to he temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the
same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
tion, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to Hallenbeck Funeral Home 4 2nd Ave. Gloversville, N.Y.
(Name) (Address)
the A.1bert....L. Bayless Jr.. to hold temporarily and Int r the body
Dated(Undertaker or person having charge of �rse)
111 (In a ��poF( e how))
May 19
(Signed) I
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.
FORM VS. S1. (REV. 6/63) (9A2-205) 91