Buckbee, Harriett Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Illi"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 COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No. Registered7 No
County "h Date of Death N S C 7 I `z"
Town,brit.'
• ..._.........._......--•................................. Sex- Age An'Yrs. Color.
l �I (Or Mos.)
(Cross out namesnot anDllcahle)fl /�J .
Cause of Death �- � br(y�, I ,- O-1L,{st424,„„ �
Place of Burial / yre, ,�Ceme- Date of Euriah._f�/° ig_
(or Removal) terms
A CERTIFICATE OF DEATH of ' " , // G .Cr�:.�6-
(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 abovf stated Registered Number,and on the basis thereof I H REBY GRANT A ERMIT
(Name of Undertaker) ( ,
the to .
(U ertaker or person having charge of corpse) (Inter .ov of •e ispos .of[
� . - Iq.2-:Z- (Signed
Dated.- . ....
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any d the
State (subject to local cemetery or other regulations), provided, that where removal is by co on c ier.
the above Permit must be included in the Transit Permit.
sssss... .. es...
I
„.........1 L-9-22-75,00U(21-15(15) 1
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS
OR CREATIONS ARE MADE
Date of
(Internicnt,fccremati:),u) ,'
. ,
(Person
in charge)
(Name(f Ce etery,C:cmatorium,etc.)
Person in charge must return thir Permit to Registrar of h:s District within
SEVEN (7) DAYS from above date. II 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 winch cemetery is located:
EXTRACTS FROM LAWS OF 3913,CHAPTER 619,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 t e body. * * * The undertaker shall
deliver the burial permit to the perso in charge of the place of burial, before
interring or otherwise disposing of he body; or shall attach the removal
permit to the box containing the col.)se, when shipped by any nsportation
corenvary; said permit to accompan the corpse to its destin , where, if
within the state of New York,it sh.11 be delivered to the'pe 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,refnove
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 df 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 undeaker; which record shall at all times be
open to official inspection, providec that the undertaker or person having
charge of the corpse, when burying ia body in a cemetery or burial ground
having no person in charge, shall Sign the burial or removal permit, giving
the date oft burial,and shall write acrpss 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.
rig—SEXTONS and UNDERTAKERS violating the law relative to the re-
turn of permits are liable to a penaky 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. . 7
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