Prestau, Charles Forrn VS No.61
STATE D NEW YORK
DEPARTMENT OF HEALTH
OFFICIALALBANY
P�This Per BURIAL (OR REMOVAL)
lion District mil can be signed only RECT AND Permit
can
Village, y by the Local Registrar(Deputy PERMIT
COMPLETE ERTIFICATE in which the death occ or Dist. OF D urre WRITTEN IN Dstrar
NO.-__-" __ NTH. LEGIBLYaer the FILIN )of the Pri
IN G and mary Re$COR-
County_____ DURABLE BLACK i of
Town, NK.
Vil- -- -•------ Regfstere
lage, or City r�I No............................
Date of
(cross y'----- ....._.._ ---• •-- Death.......
out names n
Plicable) -, Sex_
A(...
Cause of D / , -- Age_.. Yrs. I-
Place of Burial---,��c�� A
(oY os.) Color
itt
(or Removal)
A CERTIFICATE OF :._ ___
tery
DEATH of______ � '` �jof urial-
havjng been presented to ��/J"' (.
f--- IgI same aPPearin me containing (Give full name of deceased
LAW I have accepted to be COMPLETE,COe above stated - ) examination,
above stated Ated the same for registration, ANDparticISF and RYer careful Ua ED B
isSATISFACTORY, RY ASo al
j�- red N have recorded ACZ O
to mber,and on the it RREQUIRED BY
asis thereof my Local Record
(Na.. f lInde EREBY G with
th ----. _ _ A PERMIT
i.
zZig
�y
Dated.____ ' r P?—haven R
g charge of co t0_;_ ress)
e)__ IgI (Int o - - .....-y
State This Permit is sufficient (Signed) or
aker
the
ise die se of body,
(subject tofor the _ [sta�ehow]).
the above Permit local cemetery or other regulations)
(and IntermentLoco
must be includedy '
in theern providedrem Registrar
Transit Permit. t t where 1 n)of a body to e removal is by.c any part of the
State carrier,
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR_ CREMATIONS ARE MADE
Date of.._.._... 1;LL , ,jU�, rer-<-_
fir, -- ( er cremation)
(Signed) v
(Person C 77
in charge) !
(Name o e etery,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 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 v4ich cemetery is located.
EXTRACTS FROM LAWS OF xgr3,CHAPTER 6x9,ARTICLE so.
§ 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
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,
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 shall inter or permit the interment or orner
disposition of any body unless it itt 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.
Or 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. Locar Registrars,are required,under penalty,to report
violations thereof.