Denison, Irene Form VS No.61 NEW YORK CG�.(i '�3
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 RECTDistrict
CTow LETE CER or TIFY ATE OF which
DEATH,death
LEGIBLY WRITTEN IN DURABLE BL FILING and ACK INKaCOR-
O Regist d No. .___ _..
Dist.No..- z
County & Yt4gA/tj
e of Dea -------. 9
� � Yrs. Color
Sex.... _r Age (Or os.)• laso,or`City • '
(Cross out names not app'cable)
Cause of Death- .. r
Cem ate 19I
•
Place of Removal)
ter --•
(or Remooval) '--' - - - - - - - -• -
A CERTIFICATE OF DEA H of `
ivefallna of deceased) /
having been presented to me containing the above stated p rticulars,and,after careful examination,B
the same appea ing to be COMPLETE, CORRECT, AND
Drecor SATISFACTORY i AS
Local REQUIREDecord with
LAW,I have cce ted the same for registra • n, ERE my A PERMIT
the abo to egistered Nu r,an th asis �� �
1� �1("T
to •--> - -•--•- •f dre----- bo
Name of dertak - / �.` if
to y
the.. (U - or - ---' (Inter ove,or ol,�rwis:,dispose of a ow
(Un,i ak•, or per on avi rge of co se) � � s t
I L (Signed)__- - - - --•--
Dated 9 Local Registrar
This Permit is sufficient for the moval (and Interment or Cremation)of a body to any part of the
State (subject
Permit must be cemetery
othe
he rgal Transit Permit.ovided,that where removal is by common carrier,
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS/ /ACRE MADE
Date of e ,4,t g — 1.,- -, x.ZY.r9r .f'7
(Interment or cr atio•:)
(Signed I, t_.
(Person
in charge)YC',1.--C...c.c
(Name of Cemetery,Crematorium,etc.)
Person in charge must return this Permit to Registrar of his D. trict within
SEVEN(7) DAYS from above date. If no person is in charge, e UNDER-
TAKER MUST SIGN ABOVE STATEMENT,write across the face of the Permit
1..,
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 1913,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
company; 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 ody is to be made within the state,the word-
ing of the burial or removal permit may be limited to a statement by the
istrar,and over his signature,that a satisfactory certificate of death,having
b en filed with him, as required by law,permission is granted to inter,remove
M 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
• terments or cremations are made shall inter or permit the interment or other
i position 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
J 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 stating
- 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
srson in charge,"and file the burial or removal permit within three days with
ehe registrar of the district in which the cemetery is located.4,,,
.
far 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.