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Weaver, Sarah Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT VW-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 aCOR- RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No._ Registered No County _-> 10... - Date of Deat ._.__Ceet,L'c Z Z- z:Z--- Town Vil- •� Zyt � -3_.Yrs. Color__. lage,or City Sex.. �j `ctge ! (Cross out names not applicable) (Or Mos.) • Cause of Death Plate of Burial - Ceme / - f (or Removal)--- - M:Xs tery ` ate '.y�r�+� Z qI. A CERTIFICATE OF DEATH of �.w1_. _r_,e-- (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 urn ,and on the basis thereof I HEREBY GRANT A PERMIT to -C / �, ..._... (Name of Xi nd a&et) �. the to Ate - the bod, (Unde er or person having charge of corpse) (Inter,remove,• •>_• - . o of[state howl Dated _ _ '.— 3 191:_.1 (Signed)._._ .1--- -- . .v__r__-..• ,/ Local Registrar Permit is sufficient for the Removal (and Interment or Cremation .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). ENDORSEMENT OF SEXTON OR PERSON IN I J CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of rex (Interment or cremation) (Signed) ,+. (Person in charge) (Name of Cemetery,Crematorium,etc.) Person in charge must urn this 1to Registrar of his District within SEVEN (7) DAYS from ab date. no person is in charge, the UNDER- TAKER MUST SIGN AHOY TATE ,write across the face of the Permit the words "No person in charge," an FILE PERMIT WITHIN THREE (3) DAYS with Registrar of ID.hict in ch cemetery is located. EXTRACTS FROM LAS OF rgj$,CHAPTER 6s9, ARTICLE ao. ¢ 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 the body; or shall attach the removal permit to the box containing the corpse,when shipped by any transportation o to e of-the place of burial. § 380. Duties of undertakers; terment 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 atement by the registrar,and over his signature,that`a satisfactory certific of death,having been filed with him,as required by law,permission is gran to inter,remove ear dispose otherwise of the body,stating the name,age,s cause of death, and other necessary details upon the form prescribed by, e commissioner of health. ¢ 381. Interments. No person i in charge of any s.es on which interments or cremations are made shall inter or permit theerment or other disposition of any body unless it is accompanied by a bull, cremation or transit permit,as herein Provided. S .h person shall endorse on the permit, the date of interment,or crematio•,,over his signature, andisthall return all permits so endorsed,to the registrar. his district within see days from the date of interment or cremation. He hall keep a record of at bodiesinterred or otherwise disposed of on the pr ''.. nneter his charge,in h case stating the name of each deceased person, of death,: date of b al or disposal, and name and address of the and 6 ell which record shall at all times be open to official inspection,: provi that the undertaker dr person having charge of the corpse, when;burying; _ body in a cemetery or burial ground having no person in charge,' shall , the 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 X;le the bq 1 or removal permit within three days with the registrar of:the district in. .,ich the cemetery is located. Qom'SEXTONS and'UI% RT ' 'RS violet' the.law elativetothe're- turn of permits are ' le'to a Ity.of 1 s T LES THAN FIVE DOLLARS NOR MORE THAN F—MY-DORS-ItiR THE FIRST,OFFENSE. The law will be enforced. Local Registrar ,are required. under penalty,to report violations thereof.