Euglauder Jr, Nathaniel Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q 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.._-,!.fo U_(
County i at J Registered No.
UGC Date of Death..._.. .1
ltsgerer-City------- - __ - 3-Zte, .._„ Sexilao
y
(Cross out names not ap 'cable) Ag6.s r Mos.) i9• ColOF... rr ',G-
Cause of Death.
9 (Or Mos.)
Place of Burial -'
(or of Burial Ceme- __ Date of B ��
A CERTIFICATE OF DEATH of_..21 - . el
having been ( we full name of deceased)1 gpresented to me containing the above stated particulars,and,after areful examina$Son,
the same appearing to be COMPLETE, CORRECT, AND SATIKACTORY AS REQUIRED BY
LAW,I have accepted the same for registration, have recor it in my Local Record with
the//ab`bo/ve s ted Registered Number
'and on t is thereof I HEREBY GRANT A PERMIT
to...[�t!- N�ame� &7 _.f..� E� 1.. _..».._.. . .
the 1�2LLD' `'.�ddress) ---�
to. -
eft er or person havi charge of corpse) the body.
(Un
Dated..-. „4. -_ nte�,a. ,1 ove or otherwise dispose of[state how}}
tg (Signed). :
trar
State Thia Pe�nit is sufficient for the Removal (and Interment or Cremation)of body anytoLocal y
the above Permit must be incluect to local ded in or the Trer ansit P rt)mi provided,that where removal is by part of this
common carrier,
5-23-18-25,000(21-10523)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CRREMATIONS ARE MADE
Date of- x9r
/ .•- •.4! or cremation
(Signed). I /ltA
(Person
in charge) -7" ''v
(Name of Cemetery,Cre orium,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 1g13,CHAPTER 619,ARTICLE So.
§ 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 it? charge
of the place of burial.
§380. Duties of undertakers; interment within the state. If the inter-
snent,or other disposition of the ody is to be made within the state,-the wort-
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 otner
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
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 tinges: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 buriail or removal permit within three days with
the registrar of the district in which the cemetery as located.
QW"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 mill be enforced. Local Registrars,are required,under penalty,to report