McLecce, Joseph Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ice'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 LLTE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No. ®l Registered No.
County 4�/J���� � ��__, Q� Date of Death- 0'' — �91 1/43—
� Sex__ Age_ !-- -_ rs. olor ti�Gf%(-le-t
lags,er City (egos.)
(Cross out names not applicable)
Cause of Death __-_- E- �`r" ^'
Place alit11141 w Cemea of'Burial 6—r91_J —
(or RAtnoval) --- S,,
A CERTIFICATE OF DEATH of____ __.___ ___ >
(Give full name of deceased)
having been presented to me containin e ab e stated particulars,and,after careful examination,
the same appearing to be COMPLETE, ORRECT, AND SATISFACTORY AS REQUIRED BY
LAW,I have accepted theer same for registration, have recorded it in my Local Record with
the above stated wed Number,and on the basi h eof I HER GRANT A`P_ERM IT
to.��[. ��.' - >7
(Name of d ( )
the to they ody.
(Und aker or ers &ving charge of co (Intes,r7nov9'oth se dispos f[state how])
Dated_1 a 91 3,1 (Signed) A✓� !' •
Local Registrar
s Permit is sufficient for the Removal(and Interment or 7 'r:'�..-'"o a body to any part of the
State (subject to local cemetery or other regulations), provided,the here r moved is by common carrier,
the above Permit must be included in the official Transit Permit(For r�S No. .2).
12.1714-26,000(21-2866)
IIIIIIIIIIIIIIIIIIIIIII
.•...
,
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
\ M NTS OR CREMATIONS ARE MADE
— ,
IA. e ammumi
Date of
ir
itilelp nterment or cr ation
- )
(Signed). 41.erotomege...04410'
(Person
in charge) t-- .
'Name of CemXry.(rematorium,etc.)
,
Person in charge must return thi ermit to Registrar of his District 'thin
SEVEN (7) DAYS from above date. If no person is in charge, the DER-
GN OVE STA MEET,write across the face of th Permit
DAYS with Registrar of DiStrie itx tc cerae 00' , cate .
EXTRACTS FROM LAWS OF r9z3,CHAPTER 619, ARTICLE do.
§ 379. Duties of undertaker. In each case the undertaker, or person
having charge of the corpse,shalt Ole the certificate of death with the registrar
of the district in which the death occurred and obtain a burial or removal
permit prior to any disposition i of he body. * * * The undertaker shall
deliver the banal permit to the Ile ' in charge of the place of burial, before
tw
interring or otherwise disposing the body; or shall attach the removal
Permit to the box containing the pse,when shipped by any transportation
company; said permit to accompany the corpse to its destination„where,if
; § 389. 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 6 satisfactory certificate of death,having
been filed with him,as required by la*,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.
IV
. .
§ 38 . Ird Me
.
disposi any, dIW tan it Is aectranpaniq3jir a burial, nation or, '
transit anoint as herein Pro ded. Such pottiest shall endorse anon,the permit,
the date of interment, Or cremation,over his signature, pd shall retureutill
permits so endorsed to the registrar of his 4Rstofirt wit 'en days froth the
date of interment or cremation, lIe shall,keep ies interred
or otherwise disposed of on the premises.unher hie charge,in each ease stating
the name of each deceased person,place of death,date of burial or disposal,
. and name arid address of the undertaker; which record shall at all times be
open to official inspection, provided that the undertaker or person-having
i dlarge of the" " :the);k11444411ga a body i0', oelS ''4bur141WP,
*0,the ros/...,... ,, tit, A .t'V,tt We Is keit t.",te'i.: .: 't't.'',y,„
-_.is ,'''t, ''Ojri,
taw-sstvoitiimetatIAMTAKERS viola'.' ,,.,,- 't ' !tift%
tutu of pernsittate e to a .,. of Nar LK.t :s-t.'
MORE THAN VIM t..eV '% FOR NI* ROTOflEIIS , The Paw
will be enforced. Load, !--: ., Care required,'tinder' ' to"tetef
violations thereof.' t ,,x,