McKinney, William Form VS No.sl
NEW PORK
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, Village, or City
) in which the death occurred after the FILING and acceptance of
Dist.No. �j-_--7 a cotes>'
County- _•••.. Regi tered No............
Town, bpi}.
Sex" ` ` Date of Death"" "__ td= "._." , /j1 19 F
(Cross out names not applicable)
•• "" 67 g -Yrs. Color___
Cause of Death__ je. or Mos.)
Place of Burial
or Removal)
Ceme-
,/ --" "Date of Bur' 1" �' (�
A CERTIFICATE OF �/
EATH of_ �T•191
,! c
having been presented to me containing the above stated particulars,and,after careful(Give ull name of dec ased)
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 xamination,
the a ove stated Registered Number,and on thbasis thereof I E
Local Record with
to--. • _ B,EBY GRAN A P MIT
(Name _ker)
"�'..
the _ _of
_..
�i�Ye c•-- /�Y � ( ddress)
y.
taker or pew
-/�p wing charge of corpse) _t0
Dated__. (Int remote ` wise dispose of state the
_ °t p [
(Signed)
_This Permit is sufficient for the Removal (and Interment or Cremation)of a cal to tr
Local Registrar 'rt
an
State (subject to local cemeteryor other re '.
the above Permit must be inclued in the Transit Permit.
provided, that where removal is by common carrier,
3-12-17-25,000(21-4256)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
ME ITSOR CREMATIONS ARE MADE
Date of I�y4� 0 Oeor- 1917- /
(Interment or cremation)
(Signed) A413.1.***144")
_,
(Person
in charge) L.7 - -.- -. w�'��
(Name of Cemetery,Crematorium, .)
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 r913,CHAPTER 6r9,-ARTICLE zo.
§ 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
�...,._ .. " .
p.::mb-w y.wt'�e -ol par to its destination, woe.
as.F::.+xipQ.�, cwithin the state of New York, it shall be delivered to they person in charge
of the place of burial.
§ 380. Duties of undertakers; iutOrment 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 'nay 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,
4 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 shalt 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 stating
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:he face of the permit the words,"No
person. in charge,"and file the burial or removal permit within three days.with
the registrar of the district in which the cemetery is located.
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.