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Haviland, George E Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY tt OFFICIAL BURIAL (OR REMOVAL) PERMIT (W'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._�,d 61'a Registered No. 2 s County YJ Gl''► ri4 Date of Dea `!,. Town Vil- Iage, or City Sex7,4-4_ Age q C Yrs. Color 01'4.' (Cross out names not applicable) (Ur Mos.) Cause of Death___J4.-�-� _-_ _ Place of Buria Ceme- Date of Burial_ -_ __1g1,�^ (o7 Removal) ter `� A CERTIFICATE OF DE H of -sit ' (Giv�II name of deceased) 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 above stated Registered Number,and on the basis thereof I HEREBY GRANT A PERMIT to (Name oFUndertak r) ( dress) , the-__L.L C., .- to e1. the body. (U rtaker or person having charge of cor se) (Inter,r e�9r oth s se,of jstate how]) Dated-__-.____ 7 I9I- ^ (Signed) �'�G�/ is' 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), provided, that where removal is by common carrier, the above Permit must be included in the official Transit Permit(Form VS No.62). 12-17-11-2b,000'(21-2586> ENDORSEMETT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTp 1.M. CREMATIONS ARE MADE Date of 194- ,„ te e t or 'natio (Signed), ' (Person in charge) -J`C't-gfeV fYLT 4.*04,1 ,< ante of e y, ensatorium, Tr • Person in charge ,•ust return this Permit to Registrar' f his District within SEVEN (7) DAYS fr.', above date. If no person is in:harge. the UNDER- TAXER MUST SIGN :OVE STATEMENT,write across'••4 face of the Permit the words "No perso in charge," and FILE PERMIT, ITHIN THREE (3) DAYS with Registrar of District in which cemetery is,ocated. EXTRACTS FR s•• LAWS OF ro13, CHAPTER 6• ARTICLE so. § 379, Duties o;undertaker. In each case the 'dertaker, or person having charge of the c rpse,shall file the certificate of d ;th with the registrar of the district in whi h the death occurred and obtai.-a burial or removal permit prior to any .sposition of the body. * * he undertaker shall deliver the burial pe it to the person in charge of the ace of burial, before interring or otberwi disposing of the body; or sh.. 1 attach the removal Permit to the box co. aining the corpse,when shipped ant7 transportation ..-....ewato..--seel-iperietiteat-e-eteeennymety.eke- . 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 cremati..s are made shall inter or permit the interment or other disposition of any bt:oy unless it is accompanied by a burial, cremation or transit permit,as here provided. Such person shall endorse upon the permit, the date of intermen. or cremation,over his signature, and shall return all Permits so endorsed t.the registrar of his district within seven days from the date of interment or•• ation. He shall keep a record of all bodies interred or otherwise disposed ' on the premises under his charge,in each case stating the name of each dee,' person, place of death,date of burial or disposal, and name and addres of th.:. undertaker; which record shall at all times be open to official instle. 'on, provided that the undertaker or person having charge of the corpse, 'hen burying a body in a cemetery or burial ground having no person in .arge, shall sign the burial or removal permit, giving the date of burial,an. -hall write across the face of the permit the words,"No person in charge," a. Eta the burial or removal permit within three days with the registrar of • - district in which the cemetery is!jocated. M—SEXTONS •• d UNDERTAKERS violating the law relative to the re- turn of permits are liab to a penalty of NOT LESS THANsFrilk DOLLARS NOR MORE THAN FIFT DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. •cal Registrars are required, under penalty, to report violations thereof.