Billington, Thelma NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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. 2
Warren Town, Village Registered No.
Dist. No. 560.3. County' Irani=lini or City Glen..F.a ;1s
[If city, give street address)
Name of deceased Thelma M Billington Veteran
(If veteran, give name of War)
Single, married, widowed,
Female married July 17, '�"
Sex or divorced(write the word) Date of Dea 19
Age 55 Years Months Days Birthplace --New York
Cause of Death
Certificate was signed by Dr. Hag Kim M.D.
Address 20-..Chester...Sty....Glens .Fa ,ls.y...ITY 12801
Place of Burial (or Removal)
(If bodyis to be temporarily-he-Id. (i n s ac t
Cemetery west �0. Falls Cemetery Date of Burial July 19 19.75
(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 'otter... .. eraa...Service 13.6...Warren....St. ....(,� �ns..Fa1ls. ....NY
ame) t (A�dress)
the James B otter to hold temporarily and intear _ the body
(Undertaker or person having charge of corpse) (Inter, , or wrs ' posate how))
Dated July 19, 1975 19 (Signed)
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any of the State (subject to local cemetery or
other regulations), unless removal is by common carrier, in which case a Transit Permit(V o. 62) is required.
FORM VS. 61. (REV. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date off T � I�l�%��'v' was .� . I9 �S
(Interment or Cre )
ke4 - f ,
((Name of Cemetery, Crarateree ^ `
Section � Lot No. Grave No.
(Signe
(Person in Charge)
Address
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, writeacro
face of the Permit the words "No person in charge,'
FILE PERMIT WITHIN THREE (3) DAYS with the Rpgisf
of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDERTA ,.'
violating the law relative to the return of permits are liabl
a penalty of NOT'LESS THAN FIVE DOLLARS NOR NE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. Thki.e
law ,will be enforced. Local Registrars are required, under
penalty, to report violations thereof.