Loading...
West, Helen sowommv Form VS No.sl NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT i '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.- .10.4.1 Registered No. County...... """ Date of Death.�'La� Town, Vil- U /3 IgL-(� r, lage,or City'Cc` -t: Sex.1. (Cross out names not applicable) �~ Age -5----YTS. COlor..1!Y ^• (Or Mos.) Cause of Death...Cs�c�,��„� -/M,-'t'ti,- Place of Burial e\ p_ _ Qs,.._,; Ce7- (or Removal) " ""' '- tery Date of Burial-_ba .- lI I.le A CERTIFICATE OF DEATH of jt� O9.. _ 9 having been presented to me containing the above stated particulars,and,e afterd 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 abovelo stated Registered, -) VA Number,and on the basis thereof I HEREBY GRANTn A PERMIT to �^l o"` Yi p:..JQ'r.. WA t1® cs-xX.,J (Namentaker) of (Address) o the 61Redsc-, to . (Undertaker or person having charge of corpse) (Inter," the body. Dated Yj�€ ._ removebor wise dispose of[state how]) .... -S.^ 191,a,), (Signed) 11.. This Permit is sufficient far the Removal (and Interment or CrerI,at o1 n Local y Registrar- State (subject to local cemetery or other regulations), provided, that where removala b is by com to mon carrier, the above Permit must be included in the Transit Permit. 1240.13-23,000(21-13047) • ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of G--1�I �9r-�� n nnent or cr anon t, <Signed)-__A--- (Person in charge)•.----. me 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 to13, CHAPTER 619, ARTICLE 20. § 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 compap,y- .said permit to accompany the corpse to its destination, 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 bony 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,th`t a satisfactory certificate of death,having been filed with him,as required by aw,permission is granted to inter,remove or dispose otherwise of the body, ating the name, age,sex,cause of death, and other necessary details upon +.e form prescribed by the commissioner of health. § 381. Interments. No pe in charge of any premises on which interments or cremations are made .all inter or permit the interment or other disposition of any body unless it accompanied by a burial, cremation or transit permit,as herein provided. '•uch person shall endorse upon the permit. the date of interment, or cremati. ,over his signature, and shftll return all permits so endorsed to the registra,.f his district within seven days from the date of interment or cremation. shall keep a record of all bodies interred or otherwise disposed of on the pre. es under his charge,in each case stating the name of each deceased person, ace of death, date of burial or disposal, and name and address of the and aker; which record shall at all times be open to official inspection, provi.''. that the undertaker or person having charge of the corpse, when buryi.',:a body in a cemetery or burial ground having no person in charge, shall :gn 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 Ole the burial or removal permit within three days with the registrar of the district in'vhich the cemetery is located. Or 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.