Billwiller, Henrietta Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
to 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 acceptanrte of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
itii
Dist. Nd15�7 County Essex Village Ticonderoga., N,....X.
or City (If city,give street address)
Name of deceased Henrietta Bif ,wila,e,r
Single, married, widowed,
Sex `OX.44 lorffl. .tr.;'t....or divorced (write the word)..VLiIloWad. Date of Death.... i;?li'1 ...,2 19..4.2
Age 79 Years 10 Months- 23 Days Birthplace Hex...XArk...City.,... .,...Y...
Cause of Death Coronory Occlusion & , tiroipbps ;g
Certificate was signed by Thomas R. Cummins M.D.
Address Ticonderoga, N. Y.
Place of Burial (or Removal) .P.111�::.Vie* cemetery-Vault`, town...of...Q,uaen.ahury
(If body is to be temporarily held,fill in space later)
Cemetery Troy, N a Y• Date of Burial April 4 1942...
(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 H.....Edmond...Hro.us Bolton Ldg, K. Y,
Unde rt a( `°�''"
the to hold tempor ily nd Vault - the body.
(Undertaker or person having chary of corpse) (In , re,or otherwise dispose of[state how])
Dated Apri ...2 19..`t2.. (Signed).. .
Local Regis
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part o the State (subject to local
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Form VS 67.
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
UNDERTAKER ' S REQUEST TO DISINTER BODY
re 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
Henrietta Billwiller , who died in the* Village
(City, Village, Town)
of Ticonderoga on* Apr.il..2nd.,...19.42..., Sex...female..,
Color or race* white , Age*.....7.9...years, and Cause of Death* coronary
occlusion .and thrombosis NOW INTERRED IN.P.ine..View..C.emetery..Vault
(a) The body is to be TRANSPORTED BY COMMON CARRIER for
at
(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..tr.anspo.rt.ed by .__,.
motor hear s.e...for..cremation at Gardner. Ear ...Crematorium, Troy., N.Y.
angst Tenth t�s Si es care )o be taken to Greenwooar cemetery, Brooklyn,N.Y
( 4 nalii ttaker) BULLARD, REGAN & STA ORD, INC. ,
�y . 'z -!21 C° ! `-� • Vice-Pr,
Dated July 19..4 Adds �...
221 •�•Grlen St.. ;.•Giens , N. Y
License No. 5.30.2
APPROVAL OF HEALTH OFFICER
Dist. No.
I HEREBY APPROVE above Request d r m at Perm.-•ion--be-gganted.
(Signature of Health Officer) C-- —
Dated July L 7I \ 19....4.2
'Instructions to Local Registrar: Fill out (a) Ira, .it Permit for bodies trans-
ported by Common Carrier or (b) ordinary Offical Burial (or Removal) 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.