Bullion, Mildred MVP/ TUKK JTATE DEPARTMENT OP HEALTH
-' , OFFICIAL BURIAL (OR REMOVAL)QISF' 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 CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No. 66
5601 Warren Town, Village Glens Falls
Dist. No. County or City
If city, give street address)
Name of deceased Mildred 8ernice..Bullion Veteran no
(If veteran, give name of War)
Single, married,widowed,
Sex female or divorced (write the word) widow Date of Death 2/1 19 77
Age 69 Years -... Months Days Birthplace Tn of Kingsbury,NY
Cause of Death 4 ` -�
Certificate was signed by Dr Joseph Fein old M.D.
Address East St, Fort Edward, NY 12828
Place of Burial (or Removal) Tn of Queensbury
(If body is to be temporarily held, fill in space later)
Cemetery Pineview Receiving Vault Date of Burial 2/3 1977
(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 examination,
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 HERE-
BY GRANT A PERMIT
to `arleton Funeral Home, Inc. Hudson Falls, NY
(Name) (Address)
the Eunoral Director to hold temporarily and inter the body
(Unlertaker or p son Navin charge of co pse) er, remove, other disp f (s a how))
Dated %. X92 (Signed)
cal Reg trar
This Permit is sufficient for the Removal (and Interment or Cremation) of a ody 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. 61. (REV. 6/63) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
Date of was! ").2e4"
Cti ° 19 77
(Interment or Cremation)
(Name of Cemetery, Crtsmierter-iwur-cto:} --' --..
Section y ll ` I7 Lot No. 7 Grave No.
(Sig
(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
UNDERTAKER MUST SIGN ABOVE STATEMENT,
write across the face of the Permit the words "No person in
charge," and FILE PERMIT WITHIN THREE (3) DAYS
with the Registrar of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDER-
TAKERS violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOL-
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.
_a NEW TUKK 31A1L DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
I 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 CERTI-
FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Registered No.
5657 Warren Town, Village Tn of Queensbury
Dist. No. County or City
If city, give street address)
Name of decea.•. Mildred Berniece Bullion Veteran no
(If veteran, give name of War)
Single, married,widowed,
Sex Tema - or divorced (write the word) widowed Date of Death Feb 1, 1977
Age 69 Years onths Days Birthplace New York
a. d
Cause of Death Ci ec citi.on
Certificate was signed by Joagph Feinc,.ol(3 M.D.
// E t\t•St Fort Edward, NY
Place of Burial (or Removal) ti Tn. of Queensbury
(If body is to be temporarily held, fill in space later)
Cemetery Scotch Cemetery Date of Burial March. 18 19 77
(If body is to be temporarily held, fill in space later)
The CERTIFICATE OF DEATH containing the above stated particulars, having be n p ted to me, after careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRCD Y LAW, I have accepted the same
for registration, have recorded it in my Local Record with the above stated Registered Numbervartif9p,the basis thereof I HERE-
BY GRANT A PERMIT (Carleton Funeral Home, Inc. )
to C. Bruce Wetmore 6" Main St, Hudson Falys, Y
(Name) (Address)
the Funeral Director to hold temporarily and inter the body
(Unlertaker or person having charge of corpse) (Inter, remove, or otherwise dispose of (state how))
Dated 7 ""'V & 7 1 7 --I. 19 (Signed) -� C. IL-"`'-'.-�_
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. 61. (REV. 6/63) (4A2-179)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTERMENTS
OR CREMATIONS ARE MADE
•
Date o was >J/44 /,a� 19 7 r
(Interment or Cremation)
(Name of Cemetery,.C-zgmatorium, etc.)
Section Lot No. Grave No.
(Signed)
(Person in Charge)
Address " A
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
UNDERTAKER MUST SIGN ABOVE STATEMENT,
write across the face of the Permit the words "No person in
charge," and FILE PERMIT WITHIN THREE (3) DAYS
with the Registrar of District in which cemetery is located.
SEXTONS, FUNERAL DIRECTORS and UNDER-
TAKERS violating the law relative to the return of permits
are liable to a penalty of NOT LESS THAN FIVE DOL-
LARS NOR MORE THAN FIFTY DOLLARS FOR THE
FIRST OFFENSE. The law will be enforced. Local Regis-
trars are required, under penalty, to report violations thereof.
Form VS-67 (rev. 11/65)
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY
In completing this form, please typewrite, hand-print or write legibly all entries in permanent black or blue black
ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN"
in applicable spaces.
I hereby request permission to disinter the dead body of:
Name of Deceased (`�Male Age(yrs.)
Mildred Berniece Bullion 1�7 Female 69
Place of Death (indicate whether city, village or town) Date of Death Cause of Death
City of Glens Falls. N.Y. Feb 1, 1977 Cardiac Decomposition
Cemetery now interred Location (city, town or county) Is body to be transported by common carrier?
Pineview Cemetery Tn. of Queensbury 0 Yes N°
State fully the final disposition to be made of body.
Burial in Scotch Cemetery Tn. of Queensbury
Name of place or cemetery for final disposition Date of final disposition
Scotch Cemetery, Queensbury N.Y. March 18, 1977
Firm Name Reg. No. Address
Carleton Funeral Home Inc. 00356 68 Main Street, Hudson Falls, N.Y. 12839
'Signature of funeral Director or Undertgk er Reg. No. Date
C. Bruce Wetmore C � h El.' 05978
INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER:
1. See Section 13.1 (formerly Chapter XIII, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies
by common carriers, as printed on the back of the Transit Label.
2. The data required concerning the decedent may be obtained from the local register or cemetery record.
INSTRUCTIONS TO LOCAL REGISTRAR:
1. For bodies to be transported by common carrier, fill out Transit Permit.
2. For bodies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit.
3. In each case write the word "DISINTERMENT" on the Permit.
4. This form should be filed and carefully preserved in your office.
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