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Rawsay, Chloe Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) t�This Permit can be signed only by the Local Registrar(Deputy PERMIT Registra- tion DistrictPermit anage, or City) RECTnAND CO p in which the death occurre aterrt ebFILINGr)of acceptance of a Ct R ,LETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN Dist.No.---_ [p / and acceptance a CORD.-..------ •-- DURABLE BLACK INK. County Registered No......................... '""" Date cf Death__ / �� is a _ .. - 19(Cross out names not applicable) .. Sex.- Age.v` Cause of Death_.-_-.-_--.--_ (ems3. Color--- � . Place of Burial "''uf fr.-Z-_-_•2:7...'ZT:(-_-_-_?_--_-./,. A CERTIFICATE OF yJBurial __ DEATH of-- ���� ,� 6- 19-' R -vef --•------•-ofde-- ---- •----.---... havingbeen presented to me containing the above stated particulars,and,after careful examination the same appearing to be COMPLETE, CORRECT, (Give full name of de�eased) LAW,I have accepted tod C same for registration,RECT, AND SATISFACTORY AS the above,I acc Registerd the g , have recorded it in REQUIRED By umber,and on the basis thereof I HEREBY GRANT Record M T to _ ....,----- --- G -..--� A PERMIT(Name Underta)ce��^ • a the------ - - `�1lc c� _ (Umjart ker or - (Add ss) _ ��-......!._._ _. person ha •ng char -------•-----------te---- / Dated----------•------ }� charge o cor e) --- ----------•--------------....----••-•----•----the '•-•�•---`--u -----_I (I eve,or otherwise disppfi,. body. This mil is sufficient for the Removal Sign ___•,.--__•-.- State ...... •-.................................--• (s hiec to local cemetery Local the above Permit must be included in otheror regulations), Interment or Cremation)of a body to any the Trgulations), provided, that where removal is by r the Transit Permit, common carrier, `4 12-28-22-75,900(21-3064) ENDORSEMENT OE SEXTON OR PFP ON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of r9 (I tern it (Illation)(Signed) .. ,� (Person 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 STATEMXNT,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 1913,CHAPTER 619,ARTICLE zo. § 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 contFairuog the corpsq,when shipped by any transportation company; said permit to pccorfipany foe corpse�to ts—tte;tf?iatiorr,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 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 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. Qom'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 violations thereof.