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Scoville, Cora 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 Subre istrar)of the PrimaryRegistra- tion District (Town, Village, or City) ( A y COR- RECT AND OMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. in which the death occurred after the FILING and acceptance of a Dist.No:. County........ LI i Registered No. ` """" ate of Death_eatZ____.e......._....... ,9, .,..„„„ ........l�,gar,a,.City out names not applicable) •..._ Sex_. 4,...- Age- __YrS j19I.- (Cross ___.... Cause of Death_.. ��..__jj� (or Mos.) Place of Burial �G �I or Removal) .. o A CERTIFICATE OF DEATH of___t___- - ate of Bu • Lail* having been presented to me containing the above stated particulars,and,after careful examination, (Give full name of deceased)the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED LAW,I have accepted the same for registration, have recorded it in my Local Record wiBY th the a ove stated Regi ered umbe ,and on the basi thereoff I PERMIT _ r //aaa%%sss//������,, REBY GRANT A (Name Und L�`�`s !+5.._ � '.the.. 1 _ T (U ak to-. body. r per having charge of copse} ?Y ante Dated__._• ----•p---- -. the bo •....._,- ov oth e dis o of[state'howl)dy _._--------•----•----191--. (Signed)- - ___ ` Local Registrar This Permit is sufficient for the Removal (and Interment o rematibody State (subject to local cemetery or other regulations), provided, t the above Permit must be Included in the Tr )of a to any part of the Transit Permit. t where emaval is by common carrier, _• '- - 2-18-18-25,000(21-14071) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTSfOR CREMATIONS ARE MADE Date of.._QLt f.-l/ll- f1.- .. . LS/--. �SJStR x>r �r ( ter e on) (Signed) ter Ca' (Person in charge) (Name 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 AAOVE 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 locate& EXTRACTS FRODA LAWS OF x9r3,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. § *30. 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 registrar,and over his signature,that a satisfactory certificate of death,having been filed with him, as required by lair,permission is granted to inter,remove 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. § 331. Interments. No person in charge of any premises on which interments or cremations are made shall 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 the 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. Q 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 repprt violations thereof.