Bolster, Ella Forra VS No.61
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
M•'-'This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primer-rtsegistra-
• n Dist ° t (To n, Village, or City) in which the death occurred after the FILING and acceptane. .-.„ `'''- ...0".
s31,1411 ERTI ICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK ',,,.
1 V/..t..... Regoered No
ate of Death 4. 14
,(C
” SeASA. Agek-r Yrs. Col .,, ity-116461
t ross cat names not plicable
D /
Place of Duria C e ate of
(or Removal tery ..
A CERTIFICATE OF DEATH of
(Givedull n (of deceased)
having been presented to me containing th above stated particul s,and,after careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I h cce ted the same for regis ion, hay recorded it Local Record with
a
the ab tt egistered er on the h., thereof I GRANT PERMIT
to_ .....
,
e f Un e
Ad
the
to
„i(U
Dated on ert o p o haarge of ere (Signe
) (Inter,r ov ,or o wis ). , e bd .'F.t• . ]
t *-#4.i
t 191_
Local '-gistrar
This Permit is sufficient for the Removal (and Interm nt or Cremation)of a body to any part of the
State (subject to local cemetery or other regulations), provided,that where removal is by common carrier,
the above Permit must be included in the Transit Permit.
. ,
Ai
10-24-1(
E OF SEXTON OR PERSON IN
O' . PREMISES ON WHICH INTER—
. y CREMATIONS ARE MADE
N. r
Date of. '` .._1_�. rgr
1 r 4....(lntyg�rr�neentt or.orematiee) p fir', ~
(Signed)_-_______.12. �:•C.C_.�QJ`- -" ?,.i.f"'3, _:«:0l.as E;
(Person u"
in charge).
(Name of Cemetery,Crematorium,etc.) i.,
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 r913,CHAPTER 64,'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 s.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, Paid permi* •;) accompany the cornse.to-its.dcstination. 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,Lnrial or removal permit may be limited to a statement by the
registrar, and over his signature,that a<atisfactory certificate of death,having
been filed with him, as required by last 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 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. Ho 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 char,""and ale the burial or removal permit within three days with
the registrar .,i - d'qrict in Which the cemetery is located.
lam'SEXTJa„ " TAKERS violating the law relative to the re-
turn of_permit€ ''y of NOT LESS THAN FIVE DOLLARS
NOR MORE f RS FOR THE FIRST OFFENSE. The
law will be ars,are required,under penalty,to report
violations th(1