Cleveland, Celia 12-18-33-10,000(17-3790)
TRANSIT PERMIT
Form VS No.62
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany each
=41T a commvncarrier—Regulation 1, subdivision,1.
UNDERTAKER'S C, �TIIFICAT
x 3 iqerehg elerttfg that the accompanying dead body of LL-- -air. --
.V.
who died in th of -
p - (City,V'1 ge or Town) _
.Binglea—
A County ofowed
_ _. , State of New York,0 1 , Sex•.T.. ,
wiM3dl
es
_ .. �ri B,e3eed.
bColor or race. , Age.72 years....../ _/ s, Birthp ed .• ti ,e(�ett._•.•......_ fid Causei of
'n Death_�.. _ _... _ _ __.. ._ ._ ._._.._._has been prepared f transportation
.,i
in"=fir - - t _ Mimi I subdiv n 62-- _.-`.....--....as .nted Rnth -Wank-' s`°`�€� " _ -
+.. .. _ ..._.__.. , M. Address./ • ate of shipment...-----_...._ 4/
to 19-d-47Rou of - t
p .�-.` ; Point of
a shipmen ......
~ __; Point of destinati
�� i tore of Undertaker) /s.� /f/t ,t
i
A Date /Y s __._ 19M>r Adores �� . � . %. - •
3 - *Cross out wo ds of applying. 41 t
3f
-PERMIT;.OF- AL REGISTRAR -
Ear:Na. -' ' -,_ - R 0.fit.4-..i935
Date of issuance 19
A satisfactory Certificate of Death for above decedent having been filed and recorded in . PERMISSIi
HEREBY GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY. Sr�,
(Signature of Local Re ' r)
r' _ /
. j Local Registrar of the of ,County of '/ ..,
(City,Village or Town)
State of New York.
ISF Only the Local Registrar(Deputy or Subrr -- I may issue a Burial,Removal or Transit Perm
/= I` --ire. J... ,Iw
Detach-here - a bil11f aln""p -
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of w 19......._..
(Interment or(ceniaiies).. u/
(Signed) . ..._ _.» -,/ !''"'
Person in charge of
- W (Name of Cemetery, C etc.)
Person in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from above date. If no person
is in charge,THE 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 Registrar of District in which cemetery is located.
---.2 _, EXTRACTS FROM VITAL STATISTICS LAW
§ 379. Duties of undertaker. In each case the undertaker,"or"per, nii—having-carge of--the r+t1$1 J t_e cate of
death with the registrar of the district in which the death occurred and obtain a burial or removal permit prior to any disposition
h * _� er _permit to the person in charge of the . tot a
tirtirentit- of Tsr,or- attach the removal permit to the box _ Ireila
- -try ti any; said permit to accompany the corpse to its destination, where-if-within the -of ' l
be delivered to the person in charge of the place of burial.
§ 380. Duties-of undertakers; interment within the state. If the interment, or other disposition of the body is to be made
within the state, the wording of the burial or removal permit may be limited to a statement by the registrar, and over his signa-
ture, that a satisfactory certificate of-death, having been filed with him,as required by law,permission is granted to inter, remove
or dispose otherwise of the body,.stating the,name, age, sex, cause of death, and other necessary details upon the form pre-
scribed by the commissioner of health.
§ 381. Interments. No person`in charge of any premises on which interments or cremations are than inter-or permit
the interment or other disposition of any body unless it is accompanied by a burial, cremation or transit permit, as herein pro-
vided. Such person shall endorse upon the permit the date_o.€interment, or cremation over his signature, and shall return all
its so endorsed to the •sttur-efAis district-with• �.. F r keep
•'.� or. �. tt , ie shall
a record of all bourn te�or otherwise disposed of premises under his-ch in case-'- ..,_ `O deft-- - -,--`
deceased person, place of death, date of burial or disposal, and name and address of the undertaker; which record shall at all
times be open to official inspection; provided that the undertaker or person having charge of the corpse, when burying a body in
a cemetery or burial ground having no person in charge, shall sign the burial,or removal,permit,giving the date of-burial, and
shall write across the face of the permit the words "No person in charge," and file the burial or removal_pertnie within three
days with the registrar of the district in.which the cemetery is located.
SEXTONS and UNDERTAKERS violating the law relative to the return of permits are liable to a penalty of NOT
LESS THAN- 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- -
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