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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.