Traver, Barbara Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar.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 COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No. Re 'stared No.
County
u Vil- ate of D t � 9�
q.er. p: -• - r•`=s1A.4.
sn'�► -- Sex- Age Z _TM.. Color
(Cross out names not applicable) (Os Mos.)
Cause oit Deat __ ;_a `
Place of Burial
Came-��) . a tery - Date urial -"
19/
A CERTIFICATE OF DEATH of
ive full name of dceased)
having been presented to me containing the above stated(particulars,and,e after careful 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 above st ed Regis red Number,and on th bas's thereof I HER Y GRANT A PERMIT
to--- - . ) .b _x _F/]:._. .
ess`y)G ,
the"_ - :L__y__t__ to .�����smGnt(U rtaker or person having charge of r e) (Intv gr of r ise di the body.])
Cr,{ ,('r`./� state how])Dated _�.4.h.a .. 19
-- (Signed) t__._ �_
Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part
State (subject to local cerpeteryorother regulations), provided..that.where removal is by common carrier,
the above Permit must be included in the Transit Permit.
ENDORSEMENT OF SEXTON OR PERSON II"
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CRL�,{VfATIONS ARE MADE
Date of rt��Qa rgr.y�....
-L (Interm0
(Signed). 71 IA'
l y `.1.71'��E.-1 I(r ,4
in4.0
Pcrson -62- ��f-"" X!I
charge) • �-...._
(Name of metery,Crematorium,etc.)
Person in charge must return =s Permit to Registrar of his District within
SEVEN(7)DAYS from above dat.. 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,7vhich cemetery is located.
EXTRACTS FROM LAWS(r rgr3,CHAPTER 61g,ARTICLE 20.
§ 379. Duties of undertaker,' In each case the undertaker, or person
having charge of the corpse,shall fl"li the certificate of death with the registrar
of the district in which the deatlitioccurred and obtain a burial or removal
permit prior to any disposition of ';.he body. * * * The undertaker shall
deliver the burial permit to the per;on in charge of the place of burial, before
interring or otherwise disposing of the body; or shall attach the removal
permit to the box contain mg the rorpse, when shipped by any transportation
emp14,),.4mg®^Zkx-115o'u$'ite,lPbtniafidn, W`}hse, it .. ...
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 cf 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 otner
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.
Qar 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.