Bullard, Mary NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rir This Permit can be signed only by the Local Registrar (Deputy or subregistrar • the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING,and acceptance of a CO' 'ECT ND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Town, Village gistered No.
Dist. No. 5762 County Was'nin cton or City • n o Kin sbury
f city, give street address)
Name of deceased Mary- Elizabeth (McGann) Bullard ‘., eteran no
(If veteran, give name of War)
Single, married, widowed,
Sex Female or divorced (write the wo•.) i, o ed Date of Death Feb. 14, 19 75
Age92 Years 2 Months 2° •< Birthplace
Cause of Death zeneraliz.ad...art.er.ias.cl.=' s .s •
Certificate was signed by E.dmond..F......Lar in. ..l ...I.,. M.D.
Address No, Adams, M.. s.
Place of Burial (or Removal) .Tpwn ofOue-.. :•rv, New York
(If body is to be temporarily held, fill in space later
Cemetery Je...Ka.raS Ct e .ery Date of Burial March 29 19 75
(If body is to he temporarily held, fill in 'ace :to
The CERTIFICAT. • DEATH contai • t e above stated particulars, having been presented to me, after careful examination,the
same ,ppearing to be •MPLETE COR• ;C , AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registra-
Lion, have recorde. i in my Local Rec. • • ith the above stated Registered Number, and on the basis thereof I HEREBY GRANT A
PERMIT
to Carleton • ,.ter:l Home, nc. 68 Main Street, Hudson Falls, N.Y.
(Name) (Address)
the Funer : .et.o to hold temporarily and inter the body
(Undertaker or pe vin c arge of corpse) _.< nter, r ov or errors s ose of (state how))
Dated Marc • 2f , 1975 19 (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a b y to any part of the State (subject to local cem ery
other regulations), unless removal is by common carrier, in which case a Transit Permit(VS No. 62) is required.
FORM VS. 61. (RP:V. 6/63) (A2-248)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date ofkji-C‘xi—
was 1 9,/,lS
(Interment or Gra'trr}3(Nam of Cemetery, Cerium;-erC:)"
Section Lot No. Grave No.
(Signed) k-Z-L C2 ✓ c'
,/` (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, 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 UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars are required, under
penalty, to report violations thereof.