Orcutt, Ida Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Or'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. .‘.. 7 Registered No.
County--•- C ^*r �Dat� Age
Date of Death. LE' 1g1 -
Town, X� a t' t�Yrs. Color-�!G� �
tagerer City
(Or Mos.)
(Cross out names not„rikplica�}e) /
Cause of Death.C l�ls[rLti�nAGGt,•�l.t_ rDate
� �
Place of Burial Ceme- of Bual44.jCirqi6- - - --- - --
A CERTIFICATE OF DEAT of 941... t-- : _
(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/ve stated RegisteredC Number,and on the basis thereof II�HEREBY GRANT A PERMIT
to- �G%j --�,.L,&__V: 2a?4., `5-'� _1'Q%2.0 ..- -i:
(Nam of Underta er) _.,
,�/ y address) -..
the /. to ---24_/Q�_ the body.
(U er or persppn having charge of corpse) (Inter,r�em °,r�95herw i ate how])
Dated._/1. tZ4 2-_ Ig1_4- (Signed) 1 `>.__Li 7 �
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 z9z_._...
C 'erment or cremation)
Jfs(�
(Signed)-..A f�l
(Person
in charge)
ce e'`.S to6„144 t,ettc.)
Person ha ge slit St rehte4,110 Pen to Regatta t > s"D trlct within
SEVEN (7) DAYS from,abov&4 te. If,no person is in char the UNDER-
TAKER MUST SION,ABOVE STATEMENT,write across the f " of the Permit
the words `No person in charge," and'FILE PERMIT WIT THREE (3)
DAYS with Registrar of District ill which:cesaetery is locatee&,
EXTRACTS FROM LAWS OF'z9r3, CHAPTER 619, ARTICLE 20.
379. Duties of undertaker. In each case the undertaker, or person
having charge of the corpse,shall ale 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,whenshipped by any transportation
y; said it to accompany the cor se to its destination, where
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, cre$'!!ktion or
transit permit,as herein provided. Such person shall endorse upon the per kit,
the date of interment, or cremation,over his signature, and shall retnrA all
permits so endorsed to the registrar of his district within seven days frdm 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, dal*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 Ole the burial or removal permit within three days
with the registrar of the district in which the cemetery is Iocated,
tlr 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.