Mintzer, Baby Girl Fortta VS No.61MENEM
NEW YORK �
STATE IARTMENT OF HEALTH
ALBANY
t4"This Permit can OFFICIAL B1AL (OR REMOVAL) PERMIT
tie0 District (ro be signed only
RECT AND Wry Villa e by Local ecoccurred
Registrar(Deputy or Sub FLING) f the Primary Registrar
COMpI ETE CERTI City) in wh the death occurred after the FILING and acceptance of a COR-
Dist. CERTIFICATE DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
County............_•a__aC._- _ .. Registered No
Town,
.....•- Date of Death lage, or Cityc IgI
(Cross a -
ut names not a �' .. Sex Age
applicable) YT S. Color
Cause of Death....... (Or Mos.)
Place of Burial
(or Removal) -eme-
tery > Date of Burial I Ia
A CERTIFICATE OF DEATH 1 g
having been c �It � �_-
th,same a presented to me containii the above stated(Give
particulars,and,after
careful examination,
LAW I haveappearing to be COMPLETECORRECT, AND SATISFACTORY AS REQUIRED BY
the above stated
the same for rgistration, have recorded it in myLocal Record with
Registered Numberand on the basis thereof I HEREBY GRANT A PERMIT
to-."-------------..-
(Name of Undertaker)the.
(Address)
(Undertaker or Person to �r
Dated__......
having charge of;orpse) (Inter r o .J
I
., r ..s f 6
A J o
e ])
(Signed)
g ) ,tote how])
State �"s Permit is sufficient for the -
(subject to it i sufficient
f a bodyol tgi tray
the above per r or other reggulationsd provided Interment
where removalis by common carrier
mit must be included ino the Transit Permit.
10.24-18.50,000(21420)
ENDORSEMENT M SESTON WHIC$
MENTOR INTER-
OF
SEXON OR PERSON IN
CHARGE O
CREMATIONS ARE MADE Q
_..._._i - .._sgLq—
Date of .�-- - Interment or crematiro�n�)
45
(Signed)._._. _.___...... .........._.._.._.
(Person 'r' ......................._.._._ ___^^ - ----(I
sr charge).. --- a of Cemetery,Crematorium,e .
erson is in charge,the IINDER-
person in charge must return this Permit to Registrar of his District within
date. If ne
SEVEN (7) DAYS from o STATEMENT, rite across the face of the Permit
TAXER MUST SIGN ABand FILE PERMIT WITHIN THREE(3)
the words"No person in charge,"
DAYS with Registrar of District iact which is located.
EXTRACTS_FROM LAWS OF i9r3,CHAPTER 6r9,ARTICLE ao.
cr, or person
,:.,�..n...ue me 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 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. 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.
far'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.
r _____