Yauks, Catherine AA I
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, Villa or City) in which the death occurred after the FILING and acceptance of a COR-
RECT AND COM T�RTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No: 1 red o
Count
to of Dea / O 191,
Town,Vi / .y,�, -1z e gea Yrs. Colo
1age, or City •
. •
Y
(Cross out names not applicabl
Cause of Death_ ___..__
P(oacRem vr1) A Date of Buri 1g1__
49
A-CERTIFIC E OF DEATH of= "�.f
(Give full nam of ased)
having been presented to me containing the above stated particulars,an 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 m Local Record with
the above state, Registere. N ber,and on the basi. hereof I HER R PER T
1/ /
to t ,
. i•of ° •'- w.1---�+ ( dress
the / je to-_ e body.
.e . or.,!son haviag charge o corps (Intel m ,o i o of rs how])
Dated_ --- /L 191--t! (Signed)--
-• al Registr r - Sv�—
This Permit is sufficient for the Re val (and Interment or 1 ' -the.-§
State (subject to local cemetery or other regulations), provided, at e rem val ommon carrier,
the above Permit must be included in the official Transit Permit(Form VS No.62).
1217.1425-000(211-2568)
. „
(II
ENDORSEMENT OF SEXTON OR PERSON IA
CHARGE OF PREMISES ON WHICH INTER-
MEN S OR CREMATtdeNS ARE MADE
Date of 1....1.41„..-fa-114--- ki ...,../iii.+ . II r91 7
(interment or entination)
(Signed) ,
(Person
in charge) 4y,,,,ae-A
rz„....._.
14---leF-C...41-4.4Name of etn'etery.A1)ematoriqm,etc.)e,
Person in charge must return this Pert to Registrar of his District witnin
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 "Na person in charge," and FILE PERMIT WITHIN THREE (3)
DAYS with Registrar of District in which cemetery is located.
1
EXTRACTS FROM LAWS OF r9r3,CHAPTER 6r9, ARTICLE zo.
• § 379. Duties of undertaker. In eath case the undertaker, or person
having charge or the e,srps2,shall file the Ortiticate 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 bo v. * * * The undertaker shall
deliver the burial permit to the person in 4harge of the place of burial,before
interring or otherwise disposing of the dy; or shall attach the removal
4' permit to the bpx containing the corpse,shen shipped by any transportation
company; said permit to accompany the corpse to its destination, where,if
within the state of New York, it shall b4 delivered to the person in charge
of the place of burial.
§ .3S0. Duties of undertakers; inter ent within the state. If the inter-
ment,or other disposition of the body is til1be made within the state,the word.
ing of the burial or removal permit maj be limited to a statement by the
registrar,and over his signature,that a s. 'sfactory certificate of death,having
been tiled with him, as required by law,t4rmission is granted to inter,remove
or dispose otherwise of the body, stating he name, age, sex, cause of death,
and other necessary details upon the fou prescribed by the commissioner
of health.
§ 381. Interments. No person in charge of any premises on which
interments or cremations are made shall i ter or permit the interment or other
disposition of any body unless it is acc4mpanied by a burial, cremation or
transit permit,as herein provided. Such 4erson shall endorse dpon the permit,
the date of interment, or cremation,ove,his signature, and shall return all
permits so endorsed to the registrar of hi district within seven days from the
date of interment or cremation. He shah)keep a record of all bodies interred
or otherwise disposed of on the premises tinder his charge,in each case stating
the name of each deceased person, place hf death, date of burial or disposal,
and name and address of the undertaken which record shall at all times be
open to official inspection, p*ovided th t the undertaker or person having
charge of the corpse, when burying a b dy 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 Fie the burial of. removal permit within three days
with the registrar of the district in which the cemetery is located.
H
rw....SEXTONS and UNDERTAKERS violating the law relative to the re-
turn of permits are liable to a penalty of NCT 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. •
•