Yankerlontg, Lena Form VS No.61 NEW 4ORK
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 aCOR-
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No. U Registered No
Albany �9�
County-_. _-------._.._.__. Date of Death `�
Town,V i an V jo �/ 7
lage, or ity Sex% Aget3 Yrs. Color
(Cross out names not applicable) (Or Mos.)
Cause of Death a
rr
Place of Burial '\` 4, �f i,.. Ceme- 4,4- alp � yj(
(or Removal) ' tery ��`� Date of Burial__-- __4,`J.--..19.2
A CERTIFICATE OF DEATH of
7Y-.C2�:__ �•z c _.
( t e full name of dece d)
having been presented to me containing the above stated pt rticulars,and,of er 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 Re istered Number,and on the basis thereof I HEREBY GRANT A PERMIT
(Name of Undertaker) (Address
the to__ the body.
(Undertaker or p on having charge of corer) (Inter,r ve,or other ism spose of(state howl)
Dated i��l:c�it Jr�1(-_._- 19X7 (Signed)
Ct�sp �v2�e
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of the
State (subject to local cemetery or other regulations), provided,that where removal is by commor 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 rg.._._._
(Interment or cremation)
(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 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 rgr3,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
it prior to any disposition of the body. * * * The undertaker shall
er the burial permit to the person in charge of the place of burial, before
ierring or otherwise disposing of the_body; or shall attach the removal
it to the box containing the corpse when shipped by any transportation .
parry; aaid`'9 itoit to accccnO�aqpani n3r¢se to its destination, where,it
within the state of New York,;it sha ' e delivered to the person in charge
of the place of burial.
§ 380. Duties of undertakers; inkerment 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 ,tray be limited to a statement by the
registrar,and over his signature,that a.satisfactory certificate of death,having
been Sled 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 if'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, plal:e 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 al 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 o'-removal permit within three days with
the registrar of the district in which the cemetery is located.
Oar SEXTONS and UNDERTAK>'SRS 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