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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.