Eunice Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
frfr-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. `S G O�// Registered No. ¢
County X-.6 --- �/� `,ate of Deat __ -- Q — I9I
Town,VA- �_' .i c -ZZ �/ , Sex 7 Age - Yrs. Color �t!��Ztc�i[..
lage,ar City
(Cross out names not applicable) t� - 7`
Cause of Death.- (!
Place of Burial f ,_ Ceme- ..u,�GLiu�. iBat of Buril. - ly. _.-
A CERTIFICATE OF DEATH of____
(Give full name of decease
having been presented to me containing the above stated particulars,and,afte 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 tated Regi ered/Number,and on theas's thereofl HEREBY GRANTA PERMIT
to f 0
(Nam of ) 1`L�: :�/G
the.... ( ... - to the b dy.
(Undertaker or erson ving charge of corpse) (Inter r e,or other ' 's [state ho )
Dated ( .I- -C i9itiT ( Gr2lEd.. .-------i
Local Registrar
This Permit is sufficient for the Removal(and Interment or Crem ion)of a body to any part of the
State (subject to local cemetery or other regulations), provided,that where moval is by common carrier,
the above Permit must be included in the official Transit Permit(Form VS No.62).
12.1744-25,000(21-2556) * i""ti
S
i
3 t: `TON OR PERSON IN
,•OF P a{ „ ON WHICH INTER-
,OR TIONS ARE MADE
1 c ation)
w r
; w ry.Crematorium,etc.)
urge mag�Itsxxt Fermit to Registrar of his District within
ax from above dal' no person is in charge, the UNDER-
SIGN ABOVE STA V, ;'T,write across the face of the Permit
' person in charge, .FILE PERMIT WITHIN THREE (3)
a tray of District in „ch cemetery is located.
�.' FROM LAWS OF. 3, CHAPTER 619, ARTICLE zo.
y t ties of undertaker. ' each case the undertaker, or person
,,of the corpse,shall file=e certificate of death with the registrar
in which the death o rred and obtain a burial or removal
• fwz any disposition oft .i'•ody. * * * The undertaker shall
as i al+permit to the p- - n c
herwiharge of the place of burial, before
se disposing of body; or shall attach the removal
"** '" box°• containing the co ' ,Aiken shipped by any transportation
lord 4 no-wit i-se !l a see,' -
Within the state of New York," it shall be delivered to the person in charge
of the place of burial.
§ 380. Duties of undertakers; interment within the state. If the inter-
ment,or other disposition of the body is to be made within the state,the word-
ing of the burial or removal-permit may be limited to a statement by the
registrar,and over his signature,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 prescribed by the commissioner
of health.
§ 381. Interments. No person in charge of any premises on which
interments or cremations are made shall inter or permit the interment or other
disposition of any body unless it is accompanied by a burial, cremation or
transit permit,as herein provided. Such person shall endorse Open the permit,
the date of interment, or cremation,over his signature, and shall return all
permits so endorsed to the registrar of his district within seven days from the
date of interment or cremation. He shall 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,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 permit within three days
with the registrar of the district in which the cemetery is located.
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 report
violations thereof.