Braytone, Clarissa A Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT .
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. 1- --. Registered No.
County -_ _Date of Death t --1 r91 _
Town, V. Q+ ' . . . Sex Age Yrs. Color
lage,or City-�""" '�'a�
(Or Mos.)
(Cross out names not ap 'cable) ,
Cause of Death ._._ _ Q L
Place of Burial ,}, e` Date of Burial___ 7__191�ie.
(or Removal) - "'- ter
A CERTIFICATE OF DEATH of__. _ Q..
(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 _ O .-- a s 4..E .. ..-_.,
(Name of Undert er) n (Address)
the -_ to--------_-Q4.e ------------------_-------the body.
(Undertaker or person having charge of corpse) (Inter,remove,or of se di [state how]) s
Dated_CA-4..w...g 4-.�.. 191_1, (Signed) 71 =el j l:/
I coI Registrar
This Permit is sufficient for the Removal (and Interment or Cremhtion)of a Vody 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 Transit Permit.
1240.15-25.000(21430171
1
ENDORSEME •T OF SEXTON OR PERSON IN
CHARGE '! PREMISES ON WHI INTER—
MENT :;%a R CREMATIONS ARE MADE
i eems
Date of ! c, j ' $ sox
(Interment or cremation) ,
(Signed) y
(PersonAP
'.1� . ). , 4
•_. _. . .._
(Name of Ceuxetery,Crematori tc.)
Person in charge ust return this Permit to Registrar, f his District within
SEVEN r(7) DAYS above date. If no person is ifi ' arge, the UNDER-
TAKER MUST SI OVE'STATEMENT,write acros)t'e face of the Permit
the words "No a in charge," and FILE PERM ix. ITHIN THREE (3)
DAYS with 1tegtstr` of District in which cemetery is, cated.
EXTRACTS' :LAWS OF x9x3, CHAPTER 6sg, ARTICLE zo.
§ 379.' Duties `undertaker. In each case the undertaker, or person
having chare of the rpse,shall file the certificate of death with the registrar
of the district in w h the death occurred and obis' 'a burial'or removal
permit prior-to any sition of the body. * * *'- The undertaker shall
deliver the burial p it to the person in charge of the ace of burial, before
interring or otherw disposing of the body; or sh attach the removal
permit to the box c tining'the corpse,when shipped< any transportation
• acnnnapany the arpse..i.n..it' Pstination,. 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 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, cremation or
transit permit,as herein provided. Such person shall endorse upon 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 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 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 file the burial or removal permit within three days
with the registrar of the district in which the cemetery is located.
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.