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Brayton, Danford --- Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT it:'This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra- tion District (Town,Village, or City) in which the death occurred after the FILING and acceptance of a COR- RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No._.3 to 7 Registered No. 4-2- County 0-h/-t--4-A—e— Date of Death -_ /o 1911 Town,Vil- (1_ Sex._-...___ Age kg� or eity- ___ -` 4Qe g M Yrs. Color _-_ (Cross out names not applicable) (Or Mos.) Cause of Death..applicable), 1 n.A- _ ___ Place of Bur 1. Ceme_ �rtts.. ,Date of Burial YL-eru 1__2__191_t (or Removal) --- .. ` ... tery A CERTIFICATE OF DEATH of_5).CLIA,._ > (Give full name of dece d)* having been presented to me containing the above stated particulars.,and, 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 aboveo nstated Registered Number,and on the basis thereof I HEREBY GRANT A PERMIT to It-t-X,, eL3 .- - ri=Clt- Q the �(Name of Un rtaker) f�ddress) �� to �4LJ� es the body. (Undertaker or person having charge of corpse) (Inter,remove,or other ose of[state how]) Dated_1,6--z_l---.I/ 191/ - (Signed) Y1,,, I. on. Local Registrar This Permit is sufficient for the Removal (and Interment oi-7-ererioij of a body to any part of the State (subject to local cemetery or other regulations), provided, that where removal is by common carrier, the above Permit must be included in the official Transit Permit(Form VS No.62). ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MEOS OR CREMATIONS ARE MADE Date of f- ( Ica le (interment or cremation) (Signed) "^*,, (Person i9 , in charge). (Ngme of Cemetery,Crematorium,etc.) Person in charge must return this Permit to Registrar of his District within A,,, SEVEN (7) DAYS from above date. If no person is in charge, the 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 Registrar of District in which cemetery is located. EXTRACTS FROM LAWS OF x9x3, CHAPTER 619, ARTICLE zo. So § 379. Duties of undertaker. In each case the undertaker, or person ,,, having charge of the corpse,shall file the certificate of death with the registrar of the district in which the death occurred and obtain a burial or removal sr^. permit prior to any disposition of the body. * * * The undertaker shall '", deliver the burial permit to the person in charge of the place of burial,before interring or otherwise disposing of the body; or shall attach the removal permit to the box containing the corpse,when shipped by any transportation . company;—said permit to acco.mpanv t corpse to its destination, where if within the slate of NeW York, it 's etivered to ITie person in charge' of the place of burial. § 330. Duties of undertakers; x rment within the state. If the inter- ment,or other disposition of the body i. to be made within the state,the'word- , ing of the burial or removal permit ay be limited to- a statement by the registrar,and over his signature,that satisfactory�eertificate of death,having been filed with him,as required by la permission is granted to inter,remove or dispose otherwise of the body, stat o the name, age, sex, cause of death, and other necessary details upon thc+t form prescribed by the commissioner of health. Ii § 381. Interments. No person charge of any premises on which '\,;, interments or cremations are made sha I inter or permit the interment or other ' disposition of any body unless it is ccompanied by a burial, cremation or transit permit,as herein provided. Su person shall endorse upon the permit, the date of interment, or cremation,: er his signature, and shall return all pennits so endorsed to the registrar, is district within seven days from the date of interment or cremation. He: all keep a record of all bodies interred or otherwise disposed of on the premises under his charge,in each case stating the name of each deceased person, pla:re of death,date of burial or disposal, and name and address of the undertaker; which record shall at all times be v 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 sigh 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 Ele the burial or removal permit within three days NV,, with the registrar of the district in which.the cemetery is located. VW'SEXTONS and UNDERTAKERS violating the law relative to the re- turn 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 retort ,. violations thereof.