Ormsby, Charles Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Qom'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 . ..e` 7 Registered No !Z O
County ��r._r..r_:.t�,.R��C. Date of Death 0-4-1
---� 7 1914
Town,Vd-
-�SR au.eixs Sex"_Ylt.-. Age b Yrs. Color___ . a Vi .
(Cross out names not avplicable) (Os Most
Cause of Death_CA.a=Q-R,"--
Place of Burial eme-
(or Removal) '"" „ EJ tery Date of Burial 4 �t 1gl�f
A CERTIFICATE OF DEATH of__CoJ � tJ
(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 dc✓ • Q JJLQ J't d, `7�CRl-�/� 4- Q
(Name of Undertaker) (Address)
to s4 LSz_ the body.
(Undertaker or person having charge of corpse) (Inter,remove,or otigrcwi of[state how])
Dated CA- -c.. 6 191"6" (Signed) p•
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cr t mation f 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).
12.17-14-25,000(21-2566) •
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
M TS OR CREMATIONS ARE MADE
Date of ZAlothrie '' 44' :9r° ... ..,11.24ii,- 19x-- v
ferment or cremation)
r,-
(Signed)._...._ * ts.s"'teas: , '.pi
(Person
in charge). Ag *" 4,t ..
(Name of flattery,Crematorium,etc.)
Person in charge must return this Permit to Registrar of his District within.-
SEVEN Cr) DAYS from above date. If no person is in charge, the UNDER-
TAKER MUST SIGN ABOVE STATEMENT,write across tha 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 xpx3, CHAPTER 6x9, ARTICLE 20.
§ 379, 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
p,eminit 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
company;-said-permit to accompany the corpse to its destination, where,if
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 bdy 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 apon 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 diwed of on the premises under his charge,in each case stating
the name of eater'deceased person, place of death,date of burial or disposal,
and name:e;.==add of the undertaker; which record shall at all times be
open to a• .:+ i ion, provided that the undertaker or person having
charge of t "," burying a body in a cemetery or burial ground
having no -I ge,shall sign the burial or removal permit, giving
the date of. and' 11 write across the face of the permit the words,"No
person in arge," and Ole the burial or removal permit within three days
with the rtgistrar of thkrs.t in which the cemetery is located.
.N
SEXTONS and` . KERS violating the law relative to the re-
turn of permits are liable to.K of NOT LESS THAN FIVE DOLLARS NOR
I MORE THAN X Ds+i§` " ,FOR THE FIRST OFFENSE. The law
will be cnforcesl. yr„ 1 Y' a are required, under penalty, to report
violations thereof