Hermance, William ...,,,,,........... _
Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
LAr-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 COL RTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist.No..4,54P Regit:...red o.
County D, te cf Dea 1"0-0-1:47'1 ' / to° 19.W
Town, Vil-
•-•-ris. Color..
lage,or City— )ex-ZPL Age.
(Cross out names not appl' )
Cause of Deathazizo
__Place of Buript
• Come-
(or Removal) -- -- Ifr. idaird..„4. 1:, .1411........./e.:1941,-:-.."/
, . A iiirdi4:2
A CERTIFICATE OF DEATH of
(Give full name of deceased)
having been presented to me containing the above stated particUlaik 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 v.z..stated Rsg.i.r.tore umbsr, d on tile basis tiler f HER_E 121.0:S....RAN A firlaIMIT ,
th, to .the bo y.
(u :140...person,14,-tving charge of corpse) ante 124.:ve,or otligm ' e • se e how)
Dated. -r-- -41 7 (Signed) .--
Lo al 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 common 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
.4 ••
Date of
19-
(Inter ment•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 1913,CHAPTER 61g,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 shinned by any
-4'—tftrnatr"-Safle.to Col rtietO its (16?tinatioil, where,if
within the state of New York, it shall :c delivered to the person in charge
of the place of burial.
§ 380. Duties of undertakers; inteiment within the state. If the inter-
ment,or other disposition of the body iiY„it.4 be made within the state,the word-
ing of the burial.or removal permit nip,be limited to a statement by the
registrar,and over his signature,that a Jatisfactory certificate of death,having
been filed with him, as required by law,;pormission is granted to inter,remove
or dispose otherwise of the body, statinli,the name, age, sex,cause of death,
and other necessary details upon the fotn prescribed by the commissioner of
health.
§ 381. Interments. No person 14 charge of any premises on which
interments or'cremations are made shal inter or permit the interment or other
disposition of any body unless it is a -iornpanied by a burial, cremation or
transit permit,as herein provided. Su person shall endorse upon the permit,
the date of interment,or cremation, or his signature, and shall return all
permits so endorsed to the registrar of hp 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 iinder his charge,in each ease stating
the name of each deceased person, plaCd of death, date of burial .. 13pOsal,
and name and address of the undertakeii; which record shall at all tithes be
open to official inspection, provided that the undertaker or person having
charge of the corpse, when burying a idy in a cemetery or burial ground
having no person in charge, shall sigit°the burial or removal permit, giving
the date of burial,and shall write across he face of the permit the words,"No
person in charge,"and file the burial oi Ismoval permit within three days with
the registrar of the district in which the,cemetery is located.
t2iF"SEXTONS and UNDERTAKERS violating the law relative to the re-
turn of permits are liable to a penalty ol 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
violaiffinc thereof.