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Doty, Landon 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 Subregistrar)of the Primary Registra- tion District (Town,Village,or City) in which the death occurred after the FILING and acceptance of a COR- RECT AND CO PLE%E CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No. O Registered No. County QGziiig,G1- <- Date of Death '' 7,117 �- S✓911 V 1- `�� ""DZ�� -........_... Sex- Age- . rs. for `s��`�" • jagc,of City (Or Mos.) (Cross out names not applicable) 'Cause of Death , // Place of Burial I iK Ceme_ 4-- ate of Burial 19= (or Removal) ��� ter A CERTIFICATE OF DEATH of (G full name of deceased) having been presented to me containing the above stated p ticulars,and,after carefu examination, 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 Local Record with the a ove stated Regist red Number,and on the basis thereof I H REBY GRANT A PERMIT (Na of rta r) ddress) to • the body. the_ t re (Undertaker or per on having charge of corpse) (In Dated".." - . 19Lr (Signed) movrot se dispo of[state how)) Local Registrar This Per is sufficient for the Removal (and Interment or C ation of a body to any part of the State (subject to local cemetery or other regulations), provided,that here r moval is by common carrier, the above Permit must be included in the Transit Permit. ms .ra.rw ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of . . - 7 ',nor_ cremation) or cremation) (Signed) r( Zl....4 ( 1 (Person in charge) l (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 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 x913,CHAPTER 6x9,ARTICLE 20. § 379. Duties of undertaker. In each case the undertaker, cr 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 bura1 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 transportatiwt company; said perm ih-to accompany the corpse to iir destination, where, if within the state of 1�{flew York, it shall be delivered to the person in charge of the place of burin. § 380. Duties o undertakers; interment 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 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. Intermennyyk4s. No person in charge of any premises on which interments or crematipns are made shall inter or permit the interment or other disposition of any bdddy 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. ilk 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 FIRS OFFENSE. The law will be enforced. Local Registrars,are required,under penalty,to report •iolations thereof.