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Higley, Sterling • Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT law-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..._. I__- Registered No.. / p County Yy �� Date of Deat / --- g1 Toavn, V31- / �u Sex Age ' Col --- (Croslager or City ������////// (Or Moe.) (Cross out names not applicable) fi� s.) Cause of Death;, ,. ._ ---_ •-- _ _.. MOO of Burial Ceme � d t -* B LI91...G (or Removal) -- - tery A CERTIFICATE OF DEA of i:.__ .. -..._._._. (Give f�name of deceased) having been presented to me containing the above stated parti Mars and after reful xanvnation, 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 abo tated egist ed ber and on the basis f I HEG A PERMIT (Name of U -ertak:- � (Address) the...-.-'-.-'t i,L-1./ - -- -e to - - r- ' •--•the/�0�y. (Undertaker;r -erson./"necharge of co ) (Inter,remov is 'ilSose of sta do u Dated i OF .#4!-_0__191.6 (Signed) -•- --- '- ---.c./ . - -. _._.. ... Local Registrar This Per it is sufficient for the Removal(and Interment or Crema on)of 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 Transit Permit. 5-27-15-25,000(21.6893) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- M NTS OR CREMATIONS ARE MADE Date of `t na. 24 rgt 1[� j (Interment or c mat'on) (wed) t-�i 4-1 (Person V " in charge) (Name of Cemetery.Crematorium,etc.) Person in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from above date. If no person is in charge, the UNDER- TAKER MUST SIGN ABOVE STATEMENT,write across the face of the Permit the words "No person in charge," and FILE PERMIT WITHIN THREE (3) DAYS with Registrar of District in which cemetery is located. EXTRACTS FROM LAWS OF r9r3, CHAPTER 619,ARTICLE so. § 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 ><r pant: sigict, t Ito'"eomPany the to its destination, where,if 7 itt the state ofNew York, it shalt'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 staking 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 Ele the burial or r,,moval permit within three days with the registrar of the district its which the cemetery is located. Or SEXTONS and UNDERTAKERS viola the law relative to the re• turn of permits are liable to a penalty of NOT LESS FIVE DOLLARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Registrars are require& under penalty,to report violations thereof.