Quilford, Charles Form VS No.61
NEW YORIC
STATE DEPARTMENT OF
This P OFFICIAL
EALTH
ALBANY II
tion District Permit can be OBURIAL (OR
AND (Tow signed only REMOVAL)
RECT PtETin be gI I O in
the
t Local Registrar(De PERMIT
Dist. CATS OF DEATHeLEOiccurred afterr he FILING
of
N
Count BLY►y DU ) theBPrimaryC INK.
y__ _ RITTEN IN DURABLE
and acceptance
• ""• ' RABLE
BLACK
f g,a
la Regi, red 11l K I{ C
r ss on City Date o 0 I a o
R
names p ....-•__..._. - /
Cause of 1O e) '
Death_
r 1
Place of -. Age... ., yrs. / /
(or Removal)
%o.. -
moval) "
A CERTIFICATE , iC - `
OF DEATH er
having been •• ate o
the s presented to __ __ Burl �1 1g
LAW me have
a•appearinge t be C01 containing the above (Gi
•I have stated full name o dece
the ab/e �i ePto sam TE, CORRECT, Particulars;and, ` ) ' -
st. d Re i or registration, AND SATISF after caref
__ I I! g =� d b , nd have recorde ACin m AS RE exam/ ti
to... • n he basis the it in my Local Record IT
the... dert- EBY Q. kith
Aiiiiii
i! i.i,. A PERMIT
Dated . � . �' °n
r aving char -' -"_..
al'kz� Permit r� �'
the State (subject to oral etert the Removal. (.Signed) •a :d y r��i d � 7�.Y.
muss str ncluded for tt er emo a 1.(and Interment or ,-',+' L°p• '�" 'F ,'. �
he Transit py,) Provided,that t where
r ere re of egis ranaz �`� 1+�.
mit, at wh a body
�O removal is by common oars erg
5-23-18-25,000(21-15523) -
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
ME TS OR CREMATIONS ARE MADE
Date of_-•-- _._-..._ .. ... xpx
nt or tfation)
(Signed)..-,d43-22"-...,..
in charge)"��'•..`�-- .' _-r r«
(Name of Cemetery,Crematorium,et�~
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 rg13,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 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-
meat,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 p
or otherwise disposed of on the premises under his charge,in each case stating 3
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.
rtr 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.