Brummragin, Alice i
VIZIIIMENIIIMM•11.1.•
Form VS No.61 NEW YORK
STATE DEPARTIVNT OF HEALTH
ALI.6tNY
OFFICIAL BURIAL (01 REMOVAL) PERMIT
ti
112V-This Permit can be signed only by the Local 14etrar(Deputy or Subregistrar)of the Primary Registra-
tion District (Town,Village,or City) in which the deit occurred after the FILING and acceptance of&COR-
RECT AND COMPLETE CERTIFICATE OF DEATH, t,EGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No..ffm I Registered No.
County . A./74.2:../4„,,, ate of Death.. )4V, 2 g '9_A
xwat414- 46.4-z4/ i,FtrEL ....... Seitelk- Age $.5 3.Yrs. Color..e .
lagerm.City
(Or Mos.) -- -
(Cross out names not appli,,egl • •
Cause of Death _
... „4.
str
Place of Burialin ).1en4mArkt,,, s.( Ceme- 1_
te of Durial.e.6e. .. 4_1 2 9 or Removal) - txrzw
" 9-----
A CERTIFICATE OF DEATH of.... . ...-114.4.e_
(Give f u 1 name of deceased)
having been presented to me containing the abol.;e stated particulars,and,after ca 1 examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS EQUIRED BY
LAW,I have accepted the same for registrati,on, have recorded it in my Local Record with
the above s ated Regist ed Number,and on tbe b”is thereof I Hy. .EBY GRANT A PERMIT
to. * 14°- eRA., ad -r--
Name of nder ker) Address)
the 7 body.
.
(UnXt/ier or persoia ng c' ge of c.,ori_se) ( ve,or ot ise se of Ist e
tated -A - r---i9.4--Y 'k't i g n e d) ...,44-24,2.. ....... . . ... ___
Loca Re•'trar
This Permit is sufficient for the Removal (and/ terment or Cremation)of a body any part of the
State (subject to local cemetery or other regulations), vided,that where removal is y cemmor carrier,
the above Permit must be included in the Transit Pero`
''••
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER—
MENTS OR CREMATIONS ARE MADE
Date of 2 5"
xg.. ."....
" • nterment ir mation) ,
(Signed) , _
(Person 40,
in charge)
(Name of cm ry,Crematorium,etc')
Person in charge must returg,,this Permit to Registrar of his District within
SEVEN (7) DAYS from above cl_9449 If no person is in charge,the UNDER-
TAKER MUST SIGN ABOU STATEMENT,write across the face of the Permit
the words"No person in'Tharge,"an FILE PERMIT WITHIN THREE (1)
DAYS with Registrar of District loft, cemetery is located.
Ai
EXTRACTS FROM LAWS „, it CHAPTER 6xg,ARTICLE 2o. 4
.§ 379. Duties of undertakeie In each case the undertaker, or person
having charge of the corpse,shall 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
ti,.. interring or otherwise disposing of the body; 017 Sii all attach the removal
4b(0,cort7..nnug •-,-,.. ,- - s,. laine.01 by any transportation
014,,,1117* ta lt1'i}ertMt C: t,CC•„,-;,,- - a -.rt,..„,-,,,, ,...,ii„,.......,,,,x,,,., .,e...,...e..,...
within the state of New York, it :11 be, ehvered to the person in char
of the place of burial.
§ 380. Duties of undubtire -, i nte . within the state. If the inter-
ment,or other disposition ollethe body is made within the state,the word-
ing of the burial or removals permit in. - limited to a statement by the
registrar, and over his signattfre,that a sat' ,ctory certificate of death,having
been filed with him, as required by lae7,permission is granted to inter,remove
or dispose otherwise of the body, at 'rig the name, age, sex, cause of death,
and other necessary details upon the form prescribed by the commissioner of
health.
§ 381. Interments. Nix 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 bilrial, 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 premiseLuncligr his charge,in each case stating
the name of each deceased person, p148 of death, date of 12prial or disposal,
and name and address of the undertAcer; hich record shall at all times be
open to official inspection, provided lept Xindertaker or person having
charge of the corpse, wWen
burying airod a cemetery or burial ground
having no person in chargershall sig th burial or removal permit, giving
the date of burial,an II ite across the ace of the permit the words,"No
person in charge,"and-fi burial gip!! val permit within three days with
the registrar of the distr which rlIP ce etery is located.
4
sair SEXTONS and l7 RTAKE S violating the law splative to the re-
turn of permits are ha II) penal NOT LESS THAN FIVE DOLLARS
NOR MORE THAN TY DOLL FOR THE FIRST OFFENSE. The
too 4
law will be enforced. cal Registr ,are required,under penalty,to report
violations thereof.