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Brayton, Francis Form VS No.it 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 COMPJ.E RTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No....__i. Re • ered No County .— f Death • l'',Y.tq let- Town,Vil- jeo • g 7 .Yrs. Color 5�` lage,or City Sex.... --. A e...----- • (Cross out names not applicable) • (Or blue.) Cause of Death.... Place of Burial Ceme- -Date of Bu • 1 Iq. z-. (or Removal) to y-. r A CERTIFICATE OF DEATH of- 477. 4 (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 abo ted a ist red mber, d on the thereof I HE BY GRANT A PERMIT �P 8 to 1- - - - I (Name of Unde r) ' (Addy the to `'=^` �, the body. (Un er r erson havin�,�harge of corpse) (Inter �q or othlwisee dispose of(state how]) Dated o ' `5 I9___— (Signed) ��C1 l.I...._�K• __# Q. Loca l Registrar This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of time 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. ,m..... vie 14/4S-iO,VW(21-/0UO) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of r r9..._..._'y (Interment or cremation) _(Signed) k (Person ,.` . in charge) 1' (Name of Cemetery,Crematorium,etc.) Person in charge must return this Permit to Registrar of h's 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 WITIIN THREE (3) DAYS with Registrar of District in which cemetery is located. EXTRACTS FROM LAWS OF 19r3,CHAPTER 6r9,ARTICLE Zo. , § 379. Duties of undertaker. In each case the undertaker, Cr 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 a.eeaxnpany the""corpse to its ds t:aation,.c:h,,o, .f 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 +ignature,that a satisfactory certific:to 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 ven days from the date of interment or cremation. He shall keep a.record all bodies interred or otherwise disposed of on the premises under his charge, n each case stating the name of each deceased person, place of death, date burial or disposal, and name'and address of the undertaker; which record s.iall at all times be open to official inspection,provided that the undertali r or person having charge of the corpse,when burying a body in a ceme4,y or burial ground having no person in charge, shall sign the burial or r4rioval permit, giving the date of burial,and shall write across the face of the pftmit the words,"No person in charge,"and file the burial or removal permit (thin three days with the registrar of the district in which the cemetery is located. Or SEXTONS and UNDERTAKERS violating the le w 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 FIR IT OFFENSE. The law will be enforced. Local Registrars,are required,under penalty,to report violations thereof.