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Stickney, Marjorie Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH • ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT ice'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 i AND CO LETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No... 0 Det.Coun _..___t••, Registered No.------. '� r �� Date of lleath-_-n c4/` ' , _ittge764,City-•„•-----•--......._. . Q ,� or.....:.......•I f -, (Cross out Sex._.. o names no Lille e) - --.. Age----------------Yrs. Color_. .........Cause of Deat -- _ (Or Mos.) Place of B ' ` ---- -Cem - (or Remova r- A CERTIFICAT OF DEAT - v1C?.rit!5.e,5 J/ a e Burial- Z-�// having been presented to me containin the abov the same appearingo (Give full name no ,d afterf ._ tion• LAW,I ha accepted be COMPLETE,for registration,R ted particulars,and, Y AS R AND SATISFACTORY o a xamination the a ye recorded it in myUIRED BY e to istered tuber,an on th Local Record with sis thereof I BY NT A PERMIT e f Unde ake the...................... Un or erson h ing of co to (In r ss - ••-., Dated................................ rp¢e) --- the od . r o p f state howl) (Signed) s This Permit is sufficient for the Removal (and Interment or r State (subject local cemeteryor other regulations), Local Registrar "'" a above to must be d in the Provided, th ae on) a body to th here re any part of the Transit Permit. oval is by common carrier, 3-12-17-25,000(21-4256) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of ---. ..._-•----....----•- - -'�' �a✓ ,�.... rg m •crem ion) (Signed) (Person Ps in charge) s'77j/ (Name of Cemetery,Cre orium,etc.) /1 Person in charge must return this Permit to egistrar 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 19r3,CHAPTER 61g,ARTICLE 20. § 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 permitto 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 wit is the state of New York,it shall be delivered to thr person i^ 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 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. 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.