Stevenson, Charles Form VS No.61
NEW Y®RK
STATE DEPARTMENT OF HEALTH
OFFICIAL $ ALBANY
This Permit can be signedBURIAL (OR REMOVAL)
tion District (Town, only by the Local Registrar(Deputy PERMIT
RECT A Th COMP $ age' or City) in the Registrar
occurred after
TIFICATE LEGIBLY Put or NS IN DU ABLE the PrimarNReg;stra_
Dist.No, OF DEATH, the FILIN
H KITTEN IN DURABLEacceptance of a COR-
County__-------••• -- BLACK INK,
Town, �. �-"....._.. Regist eel ___
ToN. er.a67,._--• D to of Death_.-
--No-- �� .__..
(Cross out names not a SeX.._..-_
applicable)
91_�"
Cause of Death.. Age_, --_ rs.
Place of Burial .(Or os) Color__.._-
or Removal)
A CERTIFICATE OF DEATH tery _.---•- -•--•_-•--Ceme-
--•.._._Date of B i I.
having been of -- ----------- ------------ -- ------- -- /1 t.
the same a presented to 9r.-.-
ppearinrr me containin (Give,full name of deceased)
LAW,I to bet COMPLETE g the above stated have accepted the same for registration,REC particulars,
CORRECT, AND
the ab estate and,after caralul examination,
g SATISFACTORY
Re fR}PYed , have recorded it in AS REQUIRED BY
to______.__. -_ ad er,and on the basis
ere I HER Y Local Record with
(Name of Un 1'GRANT A PERMIT
the---___--- r) ,
----------------------------
(U taker "----------------------------
Dated. d person vi . chargeto___•___, (A
(subject of corpse
�9 ) 'Ve o_ thew '
is Per Signed)__ ow..
. r o L i dyS�ose 9"----the body.
Statem, is sufficient for the ""' f[state howl)
Dated
to local cemetery •---•••-••-..•-.-- _
the above PermitRemoval (and must be inclued in the re Interment or Cremation) Local Registrar
Transit Persmit provided, that where removal is to Part of the
f a bodyany
'- _, Y common carrier,
mistamosiow
2-18-18-25,000(21-14071)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date cf rgr..,...__
(Interment or cremation)
(Signed)
—
(Person
in charge)
(.ra of Cemetery,Crematorium,etc.)
Person in charge must this Permit to Registrar of hip District within
SEVEN(7)DAYS from abo d If no person is in eharde,the UNDER-
TAKER MUST SIQ•N ABOVE ST , LENT,write across the face of tine°Permit
the words"No person in charge,"at FILE PERMIT WITHIN THREE (3)
DAYS wi ' Reg' trar�of District wh' cemetery is located.
EX`' :CTS FRONT LA 13,CHAPTER 6,10 ',ARTICLE 20.
§ 379. of u'Bfertaker. each case the undertaker, or person
having char: .. y,rp shim ificate of death with the registrar
of the distric ich\y�e.`$eath curred and obtain a burial or removal
permit prior t. . y dispos ion of the body. * * * The undertaker shall
deliver the buria%,.ermit to=person in h ge of the place of burial, before
interring or othe-,2 e disposing of t ; or shall attach the removal
permit to the box taming t corpse,wh ipped by any transportation
company; sa' • to accuany th corpse to its destination, where,if
within the state of w York-it shall be vered to the person in charge
of the place of burs 1.
§ 380. Duti 6f tin ertakers• interment ' the state. If the inter-
ment,or other disp of the bomov 1 permi be limited to a statement by the
X1tto be mad ithin the state,the word-
ing of the burial or re
registrar, and over his s' nat e,that a tisfactory certificate of death,having
been filed with him, as q • d by law, .- ..' .i.n is granted to inter,remove
or dispose otherwise of t b y, stating e name, age,sex,cause of death,
and other necessary detail u the for. .rescribed by the commissioner of
health.
§ 381. Interments. No pers i-.,:e of any premises on which
interments or cremations are rr a hull i.,te t permit the interment or other
disposition of any body unless it accompa.. • a burial,, cremation or
transit permit,as herein provided. ch .:Air s dorse upon the permit,
the date of interment,or cremati er signa ure, and shall return all
permits so endorsed to the registr f is district within seven days from the
date of interment or cremation. s all keep a record of all bodies interred
or otherwise disposed of on the premises der his charge,in each case stating
the name of each deceased person, place eath, date of burial or disposal,
and name and address of the undertaker; ich record shall at all times be
open to official inspection, provided tha undertaker or person having
charge of the corpse,when burying a b cemetery or burial ground
having no person in charge, shall sign u al or removal permit, giving
the date of burial,and shall write across the ce of the permit the words,"No
person in charge,"and file the burial or remo al 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. ,