Numan, George Form VS No.61 NEW PORK
STATE DEPARTMENT OF H lailieb"*--4%
ALBANY ,
OFFICIAL BURIAL (O E
P i.
` •istr r)of the Primary Registra-
tion This o can be,signed r only by the el Rat r ( afte`S 7' LING and acceptance of a District (Town, City) in which the death r WRI N DURABLE BLACK INK.
COR-
RECT AND COMPLETE� CERTIFICATE OF DEATH, FCC\+V4 Registered No
Dist.No.5/1 1I 0 g%�, Z
/� J e cf Death---- --- '• - 3.„ :
County �P`'� I __ 1'!�
�"svrr,'F'fl- _ Sex . Age----4---V-Yrs. olor -
Iagerer City-- (Or Mos.)
(Cross out names pot applicable) ie
Cause of Death��}Place of Burial{ie:4 .:% ,,/ e - to of Burial__ ---.4---19_e 2
(or Removal) •'' -- -
sr
A CERTIFICATE OF DEATH of (Give,ull name of deceased)
culars,and,
the same appearing appearing to beo me COMPLETE gCORRECT,,the tatedAND SATISFACTORYeAS careful
REQUIRED examination,
BY
LAW,I have accepted the same for registration, have recorded it in my Local Record with
the abo stated Regist -d Num.er,and ant basis thereof I HEREBYGRANT......f27....... A PERMIT
-A / i/- / -------- res) ...,.................,
to. .. . - s th b( ,.• of Un 0
i (In ove,or°the�+}se d• o of[state hotile-•---•---- - .,ar .,of corpse �.'"'t�e� �
1 (U. taker or person hivin.� g' r✓ 0' ?t _...:
iy 19 4 (Signed) - t� / -
Dated-_ .�.- .- 21
LocalRegistra'rl
This Pif it is sufficient for the Removal (and Interment or Cremation)of a body to any part of the
State (subject o local cemetery or other regulations), provided,that where removal is by common carrier,
the above Permit must be included lathe Transit Permit.
9-8-20-75,000
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
TS 0 CRE ATIONS _ v rDE
Date of
ter r cre
(Signed) '
yam.
is 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 i9r3,CHAPTER 6r9,ARTICLE ao.
§ 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 bo'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 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
perftits 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.
Qg"SEXTONS an 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.