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Mosher, Chas ',Pea'd Form VS No.61 NEW YORK ���4?, STATE DEPARTMENT OF HEALTH „, 'A ALBANY "44 s,� OFFICIAL BURIAL (OR REMOVAL) PERMIT f4 "This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra- .\orP tion District (Town,Village, or City) in which the death occurred after the FILING and acceptance of aCOR- o0:.'e. RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No._3/_j�.6,�_S 7 Registered No. County YI �t"-'4'yL- Date of DeatnC-=_.=._G(:_,_ i 191_S_, Town,Vil- ((yyyy ���j,�! ,c lage, or City` Sex L4- Age or Mos.)Yrs. Color_Si✓' r.4- (Cross out names not4p lic bl ( Cause of Death!__ _ �-4r_- eM^-0-2-4 _'rrse".. Place of Burial Q �y Ceme- may, (or Removal) __ '#1n1'�_1/ u teryA� `/�/"``'"_ Date of Buri/alY/«.__/U 191.4 A CERTIFICATE OF DEATH of__ c2 — C P�fed) (Give full 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 ` L,.__(/ - L , -1i(.„.v„.-- A . Name of Unde�rt,caker) � (Address) the c /_Gs to Lei.. :A the body. (UndAttaker or perso9.having charge of corpse) anter,JeR9ve,o otherwi 'pos of state howl) Dated WI e&l...0 A.. / 1 191_6` (Signed)___.,/_!k _. ll J 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). ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of for (interment or cremation) (Signed) (Person in charge) (Name of Cemetery,Crematorium,etc.) Person in charge must return this Permit to Registrar of his District within SEVEN ('i) 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 tor3, CHAPTER 6r9, ARTICLE ao. § 374. 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 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 contpau-y; ,sai4„.t i t... + oora K..i .ks, &i tYit�;,. within the state ofNew or , t shale delivered to the person incharge 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 upon 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 '"e name of each deceased person, place of death,date of burial or disposal, name and address of the undertaker; which record shall at all times be to official inspection, provided that the undertaker or person having of the corpse, when burying a body in a cemetery or burial ground no person in charge,shall sign the burial or removal permit, giving -if burial,and shall write across the face of the permit the words,"No charge," and (;le the burial or removal permit within three days istrar of the district in which the cemetery is located. `NS and UNDERTAKERS violating the law relative to the re- liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR 'TY DOLLARS FOR THE FIRST OFFENSE. The law Local Registrars are required, under penalty, to report