Centerbar, Joseph S 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 aCOR-
C RECT AND COMPLETE ERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No.. L L.7 Registered No.
County Date of Death_--ka- 1- t- Irgi.b
Town,Vil-
lage,or City-' - - Se Age_,7 Yrs. Color J/Xt4i ..
(Cross out names not app• bl / (Oros.)
Cause of Death.,..— -� dh'L c
Place of Burial Ceme- '
(or Removal) ' i .+_ _ ry _����^^�'�"�'�' /Date of BurialrZ, ..Z. .i9I4
A CERTIFICATE OF DE H of ..-_----. _--- -- .-->..1 s _ fees........ ...«.._..
(Givefull name of deceased)
having been presented to me containi 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�re Number,and on the basis thereof I HEREBY GRANT A PERMIT
to.._L% _L:1 �-4 Yam- 9a, .__.._ - G - ..««�.««...._.. ••_ _..,
/(Nam of U erta er) ddress)
the N. to. - �r>a. .� «..__._the body.
(Und eke/or perso having charge of copse) (Inter,r o �`o se of(state howl)
Dated-- It Z--16 1g1-( (Signed) tg.- .!Gr�--__..-_..«. .«..«.«
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the
State (subject to local cemetery or other regulations), provided,that where removal is y common carrier,
the above Permit must be included in the Transit Permit.
8-2745-25,000(21-8893l
ENDORSE..,a . T OF SEXTON ffi ° ' PERSON IN
CHARGE '4 F PRE ,i ES ON ' ' ,''° II INTER—
,z"_OR C• . ,�'i ATIONS .` MADE
r
Date of .r' �r- "mil ' I. """� rgx--l- M
I r or e-..-lion) .
(Signed)-
-... - 1:..
(Person
In charge) ..,-.-
(Name of el te1 t on •+,etc.)
Person in cbarg must return tom Permit to aegis of hit District within
SEVEN (7) DAYS ozn above dailk If no person'it"+ charge,the'' DER—
TAKER Id St'SIG ABOVE STA ENT,write a the face of the Permit
the words "No n in charge,"'and FMB P r WITHIN THREE (3)
DAYS with Regis of District in which ceme a located.
EXTRACTS OM LAWS OP iox3, CRAFT . 9, ARTICLE so.
379, Duties of undertaker. In each case nt undertaker, or person
having charge of tit corpse,shall file the certificate ath with registrar
of the district inwhich the death occurred`and lit, a burial oval
permit prior to an disposition ofthe body. * `'",The undertak shall
deliver the burial• it to the n in engage of`fit a c of the 1,interring,or of disposing o$'the body; or
permit to the box. ntaining the corpse,when ski. s I.'.any transpoitat ofl
company said'pe t to accompany +e corpse sane w if
of the'. ' r fit« al.
§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 pf death,having
been filed with him,as retiuired 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 piwc.ibed Eby 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 hereinprovided. 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 front the
date of interment or cremation. He shall keep a record of all bodies interred
or otherwise disposed of an 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 bur pa body in a cemetery orburial ground
having no person in charge. shall sign the burial or removal permit, giving
the date of burial,and shell write across the face of the permit the words; No
person in charge."Ind file tire burial or r..moval permit within three days
with the registrar of the district#which the cemetery is Iocated.
Or SEXTONS,.end 7ND RS violating thfe law relative to the re
turn of permits are liable to a ye. of NOT LESS THAN FIVE DOLLARS NOR
MORE TITAN FIFTY DOLL FOR T) E'FIRST+OFFENSE. 'The lew
will be enforced.,,Local R ' s ate required, r penalty, to report
violations thereof.