La Mont, Florence Form VS No.61
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 COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No..-43"_la.,UV
Count -------- Registered No.
?a., , ��_ r Date cf Death-_- ,�...............
` --•-----
' 74—
Ier City -- -• •---/--
(Cross out names not applicable) Sexf.�!t a y'S!
S g -I----Yr, oIor" ___
(Or Mos.
Cause of Death._. _ +
Place of Burial _! Ceme-
J
(or Removal) -` ' ' - '
tery --Dat ial-"-L�L�• �y.
A CERTIFICATE OF DEATH of (19 Z
of
C,I
having been presented to me containing the above stated particulars,and eafterdcareful 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 abovyatated egistere umb nd on the asis thereof I HEREBY GRANT A PERMIT
Name o n "..-,_-"`.'�`.yS,-
-- ----
the".... - Address)
¢ P_.... ,
(U rtaker or perso a 'n .. e of c r e) to.. the bod
(In •
ove,or erwpose of 3'
r 19 (Signed)- r1
This Pe it is sufficient for the Removal (and Interment or Cremation)of a bodyto
Local " '
State (subject to local cemetery or other reRegistrar
the above Permit must be included in the Transit Permit. any part of the
) provided,that where removal is by common carrier,
9-8-20-75,000
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH I TER-
MENTS OR CREMATIONS ARE ME
Date of 1 .- 2 7—/� ._... ._._.x9_........
ter or cremation) y•
o;'
(Signed) _ _
(Person ' _ ®�+�
in charge)._'_ .- Y L. T Se 4,�`-=t '" ;ir,�-C,p'
(Name of Cemetery,Crematori�yth 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 AEOVE STATEMENT,write across`the face of the Permit
the words"No person in charge,"and FILE PERMIT WIIIIN THREE (3)
DAYS with Registrar of District iq,,which cemetery is located.
EXTRACTS FROM LAWS OF xpx3,CHAPTER 6x9,ARTICLE ao.
§ 379. Duties of undertaker. In each case the undertaker, or person
having charge of the corpse,shall file the certificate of death ith the registrar
of the district in which the death occurred and obtain a real or removal
permit prior to any disposition of the body. * * * Tolindertaker shall
deliver the burial permit to the person id charge of the place of burial, before
interring or otherwise disposing of the,.lady; or shall attach the removal
permit to the box containing the corpse;a.ahen shipped by-� a�bgly transportation
company; said permit to accompany thereorpse to its- nation, where,if
within the state of New York,it shall be,.delivered to th��iie person in charge
of the place of burial. Y ;
§ 380. Duties of undertakers; interment within the state. If the inter-
ment,or other disposition of"the body is to be made within t estate,the word-
ing of the burial or removal-permit may be limited to a tatefhent by the
registrar,and over his signriat�ure that a satisfactory certificate of death,having
been filed with him, as reiTui'red 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 commissioner of
health. ,r)
§ 381. Interments. No person in. charge of any 'premises on which
interments or cremations ac*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 seven days from the
date of interment or cremation. He shall,keep a record of all bodies interred
or otherwise disposed of,'bnthe 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 WW1 at all times be
open to official inspection, provided that- the underta or person having
charge of the corpse, when burying a body in a cemetery or burial ground
having no person in charge, shall sign $le 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 didtrict in which the cemetery is located.
Mr"SEXTONS axukUN ERTAKERS violating the law relative to the re-
turn of permits are Habib to penalty of NOT LESS THAN FIVE DOLLARS
NOR MORE THAN FIFT DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars,are required,under penalty,to report