Norton, Frank 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. -iJ9?P ! Registered No.
County C/!s/�../ . _Q ���tDatt�e of Dea + ...z. .... 9- __3
City 7r0- ,722.14-....-.,, Sex 02.Age -_-_Yrs. Color-../ �2 _
(Cross out names not ape r os.)
Cause of Death 1 �•y(�y/
Place of Burial 1frt eme-
(or Removal) ' - tery a e of rial_ ,._/ g2_3
A CERTIFICATE OF DEATH of ,
(Give f u name of decease )
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 above stated Registered imbe/,,and on the basis the eo I HEREBY, ANT PERMIT
- -J-
(Na of Unue ker) - � ddress) r
�1 ` I the............... _c �: 2cSJ to - _ the
e y.
(Und er or person havi g eh 'e of corp le) (Inter -- c,or otherw. disp f(state how
Dated -/-._, I..3_- ___19.2.5 (Signed)-_-. - /
Local egistrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to a art of the
State (subject to local cemetery or other regulations), provided, that where removal is by cc_ Cr carrier,
the above Permit must be included in the Transit Permit.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date of zg...
(Interment or cremation)
(Signed)(P ....
1
erson
in charge)
( tne of Ced(ry,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 1913,CHAPTER 64),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 box containing the corpse, when shipped by any transportation
company; said perri stination, wnere, if .....
within the state of ,8v York, it shall be delivered to he person in charge
of the place of bursa ,
§ 380. Duties o undertakers; interment within th state. If the inter-
ment, or other dispo tion of the body is to be made withq the state,the word-
ing of the burial on emoyal permit may be limited t a statement by the
registrar, and over hi;signature,that a satisfactory certi cate of death,having
been filed with him, s required by law,permission is gr ited to inter,remove
or dispose otherwise the body, stating the name, age sex, cause of death,
and other necessary etails upon the form prescribed b4.the commissioner of
health.
t
§ 381. Interme . No person in charge of an premises on which
interments or cremat TIS are made shall inter or permitlhe interment or other
disposition of any b .y unless it is accompanied by ti burial, cremation or
transit permit,as he in provided. Such person shall endorse upon the permit,
the date of interme. ,or cremation, over his signatunctt and shall return all
permits so endorsed the registrar of his district withi seven days from the
,-.: Ix
date of interment or motion. He shall keep a recor of all bodies interred
or otherwise dispose f on the premises under his charg•;,in each case stating
the name of each deejeased person, place of death, date,of burial or disposal,
and name and addresi of the undertaker; which record,,shall at all times be
rognmetoof ofgeoialroirpnszeiewtirro, .rooryviicliegd a tlii3aotdytlioe aunccleemrto,erry oror personburia 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.0ermit the words,"No
person in charge,"and file the burial or removal permit ithin three days with
the registrar of the district in which the cemetery is lo ated.
stir SEXTONS and UNDERTAKERS violating the aw relative to the re-
turn of permits are liable to a penalty of NOT LESS TiIAN FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FI IST OFFENSE. The
law will be enforced. Local Registrars,are required,wader penalty,to report
violations thereof. ; ,