Hopkins, Catherine Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q 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 aCOR-
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No._ .__ ‘Z Registered No.
County____ _ _ . .__ Date of Death / 2-7
Town,
ifg Pi+y -• Sex__ Age G 4L Yrs. Color__..
(Cross out names not applicable) (O •
Cause of Death
Place of Burial ,'�� e eme-
(or Removal) ._ --- -ter • Date of B -21
-19;
A CERTIFICATE OF DEATH of c ,ce
(Give full name of dece ed)
having been presented to me containing the above stated particulars,and,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
'Elie:137 stated
Regi ered Number,and on th bag''' thereof I HEREBY G NT A PERMIT
Name Un ) (Addr ss) ,
the to t the body.---
(Un taker or person having charge of corpse) (Inter, ove,or otherwise dispose o to how])
Dated ..--'21 IOW.- (Signed)
"`✓ Local Registrar
S This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the
tate (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.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER—
MENTS OR CREMATIONS�� E
Date of �__.....�..K-.IC 1.--IL! ct4''! exys__-
Inter e.i t ..ti m)
(Signed) G,40 4..1or�,0 _
n charge)
L /' l-1 g ,
in char a ___.._.._.
(Name of Cemetery,Crematorium,etc.) M
Person in geopust return this Permit to Registrar of his District within
SEVEN(7)DA frpm 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 persoi.in charge,"and FILE PERMIT WITHIN THREE(3)
DAYS with Registrar of District in which cemetery is located.
EXTRACTSrFRgM LAWS OF xgi3,CHAPTER 6xg,ARTICLE 20.
§ 379. Duties vlf 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 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 rArfoval 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 necessar'details upon the form prescribed by the commissioner of
health.
§ 381. Interments. No person in charge of any premises on which
interments or crematlbfis are made shall inter or permit the interment or otner
disposition of any booAy tunless it is accompanied by a burial, cremation or
transit permit,ggs her provided. Such person shall endorse upon the permit,
the date of iniMment,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 deticeased 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 having
charge of the:corpse;when burying a body in a cemetery or burial ground
Ahavi no person ii; charge, shall sign the burial or removal permit,giving
the of burial;and shall write across the face of the permit the words,"No
n charge;'�nd file the burial or removal permit within three days with
e trar 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.