Bruso, Anna Bell 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 ofter the FILING and acceptance of a COR-
RECT AND C LFJ CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No. d Reg' red No
County .// '�� '"' _-]ate cf Death Z' 4` Z" 19
Town, Vil- '^�
]age,or City - Se Age Yrs. Color
(Cross out names not a l' o ) (Or Mos.)
pp- i"
Cause of Death__-Place of Buria i- me-
(or Removal) ` te`y� Date of"B > '. .19-1,�
A CERTIFICATE OF DEATH of ^
(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
J
the a v ted Regi e d Nu her,and on thee4e HERE �`/��GfR'AN/�y
of Undertaker Addres
the-_ ' 644 to the body.
(Un pk perso. a-• g charge o rp ) (Inter.r • • se of state how])
Dated__-- 19 _. (Signed) t- .. ..a,. . --4 4
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)off a body to any part of the
State (subject to local cemetery or other regulations), provided,that where removal is by common carrier,
the above Permit must be included in the Transit Permit.
ENDORSEMENT OF ttiEXTON OR PERSON IN
CHARGE OF PREMI ES ON WHICH INTER-
MENTS OR CRE!I[ATIONS ARE MADE
Date of rg
(Interm t cremation)
(Signed)
(Person
-', Z�in charge)
Name of C%'etery,Crematorium,etc.)
• Person in charge must return thi 'Permit to Registrar of his District within
SEVEN (7) DAYS from above date. f no person is in charge,the UNDER-
TAKER MUST SIGN ABOVE STATIC 'ENT,write across the face of the Permit
the words"No person in charge," d FILE PERMIT WITHIN THREE (3)
DAYS with Registrar of District in w ch cemetery is located.
EXTRACTS FROM LAWS OF 413,CHAPTER 619,ARTICLE 2o.
§ 379. Duties of undertaker. ;each case the undertaker, or person
having charge of the corpse,shall file`certificate of death with the registrar
of the district in which the death urred and obtain a burial or removal
permit prior to any disposition of th t body. * * * The undertaker shall
deliver the burial permit to the person n charge of the place of burial, before
interring or otherwise disposin of body; or shall attach the removal
permit to the box containing t c when shipped by any transporta,ost r�
—comeany said ner.,t �r,NAlt
wnhiti ttfe state of NeW YbfIC-it'sha be deliv to the person hi char
` 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 bf 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
e 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.
gar 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
,,inlatinne thnra.nf_