Katzman, Karl NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Vilrage, 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. 1
Dist. No. 5725 County Washington or City Granville
(If city, give street address)
Name of deceased Karl Katzman Veteran
(If veteran, give name of War)
Male Single, married, widowed, wi.dowel 1-3 7
Sex or divorced (write the word) Date of Death 19
Age 87 Years intestinal obstruction on ASHD Birthplace Poland
Cause of Death a
Certificate was signed by John E. Glennon M.D.
Address 25 Quaker St. , Granville, N,Y, 12832
Place of Burial (or Removal ... Q.1.eens. .Ury.,....New....yorrk
(If body is to be temporarily he fin spa later
Cemetery ` raaray ei'1. is Geme ery Date of Burial 1-5 19,?3
(If body is 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 Sullivan and Minahan 67 Park Street, Glens Falls, N.Y.
Underta. ef� n (Address)
the to hold temporarily and �, the body
(Undertaker or person having charge of corpse) (Inter, rem , or, ter a is e o s fe...how))
Dated Jan.. 5 19 73 (Signed) John E, le'' o , t D.
Loc 1 Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of t a State (subject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 6'2) is required.
FORM VS. 61. (REV. 6/63) (A2-248) \, \y,.