Kaplahn, Harry Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
re—This Permit can be signed only by the Local Registrar(Deputy or Subregiatrar)of the Primary Registra tion District (Town,Village,or City) in which the death occurred after the FILING and acceptance of aCOR-
RECT AND CO PLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No I' Registere No.
Coosa ' i ' / Date of Death.... i i.�
lag nr Cit ' x" - Age 6 / rs. Colo. ...._-_
(Cross out names not appli / (Or Mos.) n
Cause of Death...
Place of Buria i Ceme-
(or Removal) --� - -- -c.' - - --- y - Date f B _ 1c�
A CERTIFICATE OF DEATH o -- (Give full name of cease
having been presented to me containing the abo e s ted particulars,an after careful examination,
the same appearing to be COMPLETE, CORRE T AND SATISFACTORY AS REQUIRED BY
LAW,I ha ccepted th ame for registration, have recorded it in my Local Record with
the abov n ted Registe Num ,and on the basis th of EREBY T A ER IT
to... - tell ....._._..---... ..._. .._.-. __
(Name of Undertaker) � �'
the R, w -- to the
TUndertaker or person having charge of corpse) (Inter,remove,or otherwise dispose of[state how))
Dated 191.... (Signed)
Local Registrar
Thia Permit 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.
ENDORSEMENT OF SEXTON OR PERSu_ /
CHARGE OF PREMISES ON WHICH INTER-
MENT OR CREMATIONS A MADE
Date of '=-.:-.. .-. r
Z
"ierm:"----1-
or cremation)
t /t L)------' ; 5--
(Person ` „i0 Cc_.
in charge)
(Name 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)
DAYS with Registrar of District in which cemetery is located.
EXTRACTS FROM LAWS OF i9x3,CHAPTER 6ry,ARTICLE ao.
§ 379. Ditties 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 is 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 ha 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
of 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 ocher
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 day*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 ease 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 pperson in charge, shall sign the burial or removal permit, giving
the date of burial,and shall write across the face of the permit the wards,"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.
Car'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 4