Palmer, Mary Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
AIIBANY
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 a COR-
RECT AND£O PLEle TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURAWs BLACK INK.
Dist.No.___ _.__ Re ' ered No
County GG'Is `e/t1 Date of Dom$ " _19` .
Town,Vil- S Age% Yrs. Color!�FG
(ages or City-i �t7i� V (Or Mos.)
(Cross out names t appl' able)S --'e
Cause of Death. s1 ,‘ ..,.
Place of Burial eme- a ,/laif ri2lt' 19
ot�Removal) '""" '" s:
A-CERTIFICAT • E'TH of- • - -
(Give full name of decease4)
h g been presentedto me containing thabove ted particulars,and,after careful examination,
same appearing tolbe CONU.PLETE, CORRECT AND SATISFACTORY AS REQUIRED BY
,I have cepted the sAllie for registration, ave recorded it in my Local Record with
the above s at ii Re ered Numbend on x e basis .y eof I HE' B `aTANT A PERT'
r/
e o ndertaker) ss) /
the *''•- -- -CO c. 1t �` `` the"lbody.
(U erter or persoai_haang c arge of corpse) (Inter r z.: or otherwi dispo Hof[sttaate howl) w /
Dated-- `z �i{{ I9 (Signed)— -- 9---s--1. /I r-f-
Local Registrar
This rmit is sufficientf for the Removal (and Interment that where remon) oval a body
to
common car ierart of e
State (subj to local cemetery or other regulations), provided, by
the above P it must be included in the Transit Permit. r
'A
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
f.
t'Date of � .* ._ rg
.(Interment or cremation)
(Signed)
(Person
in charge)
(Name of Cemetery,Crematorium,etc.)
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 1913,CHAPTER 619,ARTICLE 20.
§ 379. Duties of undertaker. In each case the undertaker, or person
haying 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
ccnpaoy; said permit to accompany the corpse to its destination, where, if
New cal., it 0::.01.u9-.:n,l.ve Gd tv t:..r.person .,.c erge
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 he 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 sa:.:sfactory 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 rae name, age, sex, cause of death,
and other necessary details upon the fore;. prescribed by the commissioner of
health.
§ 381. Interments. No person in t-earge 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; rson 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 :,hall kern a record of all bodies interred
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.
rir 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.