Loading...
McEachron, Aguba 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 after the FILING and acceptance of a COR.• RECT AND MP E CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist.No.0047 Regi; ered No. County �- _-... Date of Deat1}__ : . '! Town, Vil- Se Age.__ /IrYr- Color_ ___.. _ lage,or City a '"'"" " (Or Mos.) (Gros,out names n p.li -hlz) �J17 Cause of Death- - Place of Burial Ceme- rwslt..rs• Date of.Burial_ l __19.�.. (or Removal) '- - --' -- ter A CERTIFICATE OF DEATH of___ 4 . -!''_ I' ( e full name of deceased) having been presented to me containing the a.,,. e stated particulars,and, after careful examination, the same appearing to be COMPLETE, CORR CT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registration, have recorded it in my Local Record with the above stated Reg' tered Number,and on he basis thereof I H Y GRANT A P ' IT xi to of U i ......-.... .... . di.....-L..., oeter (Addres _f the . e to a _the :;..y. (Undertaker or.perso having.charge of corpse)_ (Int :~.ve,or of 'se e of[state wi Dated__ - .r_.. �lgt - (Signed) t i)rLocal egistrar t This Permit is sufficient for the Removal (and Interment or Cremation)of a bodyto any part of e 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. e a-ut uNvv Wa-tn,; ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of ig.._...- (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- TAXER 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 1973,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 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 shipped by any transportation company; :aid permit 'o accompany the corpse to its destination,where.if within the state of New York, it shall be delivered to the person in charge 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 of 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 § `�_"" ., erments. No person in charge of any premises on which inter -mations are made shall inter or permit the interment or other disposl" ,, body unless it is accompanied by a burial, cremation or transi a O i 1t, erein provided. Such person shall endorse upon the permit, th ' anent, or cremation, over his signature, and shall return all pe .' •d'.to the registrar of his district within seven days from the d. term- t or''cremation. He shall keep a record of all bodies interred o otherwise disposed of on the premises under his charge,in each case stating ‘ntlge of each deceased person, place of death, date of burial or disposal, name and address of the undertaker; which record shall at all times be .9ppgBnn to official inspection, provided that the undertaker or person having ,charge of the corpse, when burying 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 i tittd 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. Iiikr'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 enforce ocal Registrars,are required,under penalty,to report violations thereof.