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Walker, Katherine Form 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 COR- RECT AND PLEJE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABIrE BLACK INK. Dist.No. Registere. No County of Dea r /or Torun V1 la amity Sea -. c Age__" / rs. Color_.._ (Cross out names not applicable) (Or Mos.) • Cause of Deat __ ._.. Place of BurialAW i""' ""- Ceme . .Date of Bur•a (or Removal) - 9r-=1 7 A CERTIFICATE OF DEATH of - -•having --- been g (Give.full name o deceased) 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 e s d Re istered umbe4 on the basis t eo HEREBY NT A PERMIT (Nam r -- ddress)— (Un take r person 'ng arga� c pree // ) ( ` � 'm e, or otherwise disp• o.:- ) Y. Dated_ _ l (Sign __ / This ermit is su cient for the Removal (and Interment orocal -'gisst ar - State (subject to local cemetery or other regulations), that ere of ais body to any part aofr t e. the above Permit must be included in the Transit Permit rovided, re removal is by common carrier, "r / ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of... i! f jk :. ;0:' x9f=I— (Interment or cremation) • (Signed) ._ (Person '�I `��' -K ,in charge) {dame 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) PAYS with Registrar of District in which cemetery is located. EXTRACTS FROM LAWS OF x913,CHAPTER dig,ARTICLE 2o. § 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 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 biyrial, 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,pe mission is granted to inter,remove or dispose otherwise of the body,stating he name, age,sex,cause of death, and other necessary details upon the form prescribed by the commissioner of health. § 381. Interments. No person in arge of any premises on which interments or cremations are made shall i er or permit the interment or other disposition of any body unless it is acc panied 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,"aid file the burial or removal permit within three days with the registrar of the district in which the cemetery is located. ice'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.