Seelye, Julius Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
pr 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._.4_125.7 Registered No.
County-__ Date of Death__'* '0 191,6 —
Iage or Cit To Vil-
Sex___ - Age VI Yrs. Color •►.-5,¢__
(Cross out names not applicAleb (Or Mos.)
•
Cause of)death---------------- ��
Place of Burial, Ceme Jr_
� Q ilia-- -___T.._Data of`Ixrsai =' fib'__-_19Tes
(oy Removal) '- - ., --<•- y y
A CERTIFICATE OF DEATH of Zyy
(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
(Name of Undertaker) �N l ess)
the to the body.
(Undertaker or person having charge of corpse) (Inter,remove,or otherwi e dispose(4[state how])
Dated YQ..c ._.t___ I91_f_or (Signed) 7)"1•et-._P.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cram tion 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).
12-17-14-26,000(21-2568)
1111111111.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date of........._.. /K•ut/../yl.....:.! �9r,4 r
(Intent o r ati
�i)
(Signed)......._. 01/(/
(Person �J�,.kn ... ;.,1/L i ?in charge)--..».,....._....._...�....
(Name of Cometely.Crematorium,eta.)
Person in charge must return this Permit to Registrar of his District within
SEVEN (7) DAYS from above date. If no person is In charge,,lte 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.
l'
EXTRACTS FROM LAWS OF 194, CHAPTER 6re,ARTICLE zo.
§ 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
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 rib body; or shall attach the removal
r
permit to the box containing the co when shipped by any transportation
company; said permit to accompany a corpse to its destination, where,if
within the state of New York, it shal be delivered to the person in charge
of the place of burial.
§ 380. Duties of undertakers; In erment 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 he limited to a statement by the
registrar,and over his signature,that asatisfactory 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 pertglt,the interment or other
disposition of any body unless it is aC.companied by a burial, cremation or
transit permit,as herein provided, Sugt person shall endorse aeon the permit,
the date of interment, or cremation,over his signature, and shall return all
permits so endorsed to the registrar ofins 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
the name of each deceased person, place of death,date 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 4.body in a cemetery or burial ground
having no person in charge, shall sigthe burial or removal permit, giving
the date of burial,and shall write acr*the face of the permit the words,"No
person in charge," and He the burial or removal permit within three days
with the registrar of the district in which the cemetery is located.
Vi "SEXTONS and UNDERTAKERS violating the law relative to the re-
turn of permits are liable to a penalty off.NOT LESS THAN FIVE DOLLARS NOR
MORE THAN FIFTY DOLLARS i4OR THE FIRST OFFENSE. The low
will be enforced. Local Registrars are required, under penalty, to report
violations thereof.