Springer, Benjamin Form VS No. 61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
irtr This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Reg if,ira-
tion District(Tow Village,or City)in which the death occurred after the FILING and acceptance of COR-
RHCT AND COILE.T.E CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK I �C.
Dist No. �r{/_ R • tered No.
County Q Date of Deat s,
Town, Vil �j
lage,or City 'p"^ :.l... Age Yrs. Color
(If city give t address) os,)
Cause of h _._ .._ �,a,„••_...
Place of B 1 e e-
(
or Rem ---- �4 4 4:zs.v. ---,- t y--: •- l a _7 19-JL_.
A CERTIFICATE OF DEATH o ._._ti ,a,o
iv full na a of ace'
having been presented to me containi g t e a stated particulars, and, a ;careful e mination
the same appearing to be COMPLETE, COR CT, AND SATISFACTORY AS REQUIRED BY
LAW, I have accepted the same for registration,have recorded it in my Loca Record with
the above st Led Rpgistere N tuber, d n the basi ereof REBY GR A PERMIT
to ' L/ ..r
(\a" of Underta er fAd
the to the body.
(Und aker or person a mg charg of corpse) (Int re ove,or other " dispose of istate how])
Dated 19 (Signed)
0./ • --- is r
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), unless removal is by common carrier which case a
Transit Permit(VS No.62)is required.
•
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date of — re_
—•—
(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.
SECTIONS OF THE VITAL STATISTICS LAW.
§ 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 h bu bu
rial
disposition of the body. * * * The undertaker shall
deliver 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 said permit to accompan3 the corpse-to its destination,-whereif. _
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.
§ 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 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 prem see under his charge,in each case stating
the name of each deceased person, 14ace 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 a body in a cemetery or bbuurr grout
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.
riir 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 enforced. Local Registrars,are required,under penalty,to report
violations thereof.