Di Percio, Baby Form VS No.61 NEW YORK S-g-q
STATE DEPARTMENT OF HEALTH ---_____
• ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
IlW•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 C MP ETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No. .Q_ •_- Registered No
County _ -_--....... -- _ _- __-_A__._ Date of Death g .7 19__2-
�` rz ! • .r,rQ/.. S Age Yrs. Color
City'-lager ""
(Crossout naes no gc'ab-le) ,� /�r Mos.) /� ..�
Cause eath ' '�/v�/GL - - ... i• �S/-llSl`�. / CeZ�Lt o U�f : _ ZG,
Place q€� C�tne- .. L UL Burial 30_i
(or Removal) - --- _•- ._ er �`'
A CERTIFICATE OF DEATH o �C.n_.(7-12 - 40
( ive full name of deceased)
having been presented to me containing the above st d 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 a••• stated Registered , f ber,and on the basis thereofl I_HEREB GRANT A P`M IT
to---t. i , .11 f r , Li. ----- -- T -a� ���..C!!eQ . ,�
• (.-.
the.._-- -.. . _ -_ .4e ' . , - i to - 1, - --e the 7)ody.
(U er or erson wing c •Ige o corpse) (In : 'emo ,• otherwis pose how])
Dated_ — - I2 '9a v (Si:• , .�-,pe,4'/./-• ---�__ f- -
Local Registrar
This Per t is sufficient for the Removal (and I t s� -' k - )of a body to any part of the
State (subject to local cemetery or other regulations), prooid that wit, 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
•
Date et-_.------- -- — - - - ---
r earation)
' 7
(Person in charge) ame of metery,
�+s�t>
C oriu etc.)
Person ip charge must return this Permit to Registrar of his District viithin
SEVEN(7)DAYS from above date. If no person is in charge,the UNDER-
TAKER RUST SIGN ABOVE STATEMENT,write across the face of the Permit
the words"No person in charge,"and FILE PERMIT WITHIN THREE (3)
14YS with Registrar of District in which cemetery is located.
•
EXTRACTS FROM LAWS OF 1913,CHAPTER 6xg,ARTICL}I ao.
§ 379. Duties of undertaker. In each case the undertaker, or person
&wing charge of the corpse,shall file the certificate of death with the registrar
`the district"in which the death occurred and obtain a burial or removal
permit prior to any disposition of the body. * * * The undertaker shall
d ver the burial permit to the person in charge of the place of burial, before
i�srr' or otherwise disposing of the body; or shall attach the removal
p ryj Lo the box containing the corpse, when shipped by any transportation
comeany; said permit" to accompany the corpse to its destination, where,if
wi$'tuti the state of New York, it shall be delivered to the person in charge
of the place of burial.
i4 3811. Duties of undertskers; interment within the state. If the inter-
ment', or other'disposition of the ody is to be made within the state,the word-
ingof 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
intermen)'g 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 sd endorsed to the registrar of his district within seven days from the
date of interment or cremation. He shall keep a record of ail 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 hurying a 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 or removal permit within three days with
the registrar of the district in which the cemetery is located.
lam'SEXTONS and UNDERTAKERS violating the law relative to the re-
turn of permits'are liable to a penalty of NOT LESS THAN FIVB DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars,are required,under penalty,to report
violations thereof.