West, Edward Farm VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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 COL.
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No.-
-962. Registered No.
County Date of Death".-. ./
tea,Vil- �J .
lage, oN.Gitg4111# -_... Sex-A--. Age.-r_J9-1-_"--- s. Color.. . -_
(Cross out names not plicab e) (Or 1GSos.)
Cause of Death.- ---- - ..... - _Aidelefk.e..41Cadatigt)
Place of Burial `i - CemeDate of B1 ri7 /7.i94jf.
(or Removal)A CERTIFICATE OF DEATH of teryCn 44
(Give full name of deceased)
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
the above stated Registered Number,and on the basis thereof I HEREBY GRANT A PERMIT
to.. si p,q'+Q - ---- _ 1i��154/_-"'•S r 4 .:......._...,
ame f Un erta ) d. ,.�(6ddress)
,��(
the__...... -- - - t�.dr` to.--------- - -the body,
(Unde cer or pers avin 4harge of corpse) (Inter,rew o o 'se dispo [state howl)
Dated # i ZI. (Signed) tax.
Local Registrar
TE:a it mit is sufficient for the Removal (and Interment 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.
p_t,_20-75,000
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date of
( e ent or cremation)
irkerah.
(Signed) tb
•
•
(Person
in charge)
(Name of Cemetery,Crematorium,etc.) 4‘.
Person in charge*44st...return this Permit to Registrar of his District within
SEVEN (7) DAYS front s,,1?eve date. If no person is in charge,the pNDER-
TAKER MUST SIGN ABOVE STATEMENT,write across theiace of the Permit
the words"No person in charge,"and FILE PERMIT WITHIN THREE (a)
DAYS with Registrar of DIttlict itk•which cemetery is located.
EXTRACTS FROM LAWS OF x913,CHAPTER fire,ARTICLE 40.
§ 379. Duties of undertaker. In each case the undertaker, fals 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 accomphnz.the corpse to its destination, where,if
within the state of New York, kt./tan 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 body is to be made within the state,the word-
ing of the burial or removal perNitt may be limited to a statement by the
registrar, and over his signature,thitt a satisfactory certificate of death,having
been filed with him, as required b law,permission is granted to inter,remove
or dispose otherwise of the body, ating the name, age, sek, cause of death,
and other necessary details upon/The form prescribed by the ooMmissioner of
health.
381. Interments. No person in charge of any premises ofi 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, cretion or
transit permit,as herein provided. Such person shall endorse upon Wtpermit,
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 inspecifeen, 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,andliall write across the face of the permit the words,"No
person in charge,"and le the burial or removal permit within three days with
the registrar of the district in which the cemetery is located.
(faW"SEXTONS andlIINDERTAKERS violating the law relative to the re-
turn of permits are liable to a pehtalty 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