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.