Liddle, John Form VS No. 61 NEW YORK
STATE DEPART` ENT OF HEALTH
ALBANY
OFFICIAL BURIAL (O:A REMOVAL) PERMIT
sa'This Permit can be signed only by the Local Regglistrar(Deputy or Subregistrar)of the Primary Registra-
tion District(Town,Village or City)in which the death;occurred alter the FILING and acceptance of a COR-
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No._ (D d I x Registered No�
County t`�"• a`�°•• fr Date of Death�l . g-
Town, of Glens Fag.§,
l age, or City x Age 0-6—Yrs. Color_-/Id*
(If city give street address) (Or Mos.)
Cause of Deatf
Place of Buri E Ce 1.E4 , ate of Buria 1, t '7g 19._.2 3
(or Removal) ter �J
A CERTIFICATE OF DEATH of -4,
(.. __.
( ive full name of eceased)
having been presented to me containing the a ve;tated particulars and, after careful examination,
the same appearing to be COMPLETE, CORREC,1', AND SATISFACTORY AS REQUIRED BY
LAW, I have accepted the same for registration,have recorded it in my Local Record with
the ove stated Regiil;✓tgared Number,C/§nd on hi bai thereof I E BY G17 A PER(L�Il ,
(Name o U er )to f II ddre '
the ' A - {{ the body.
dertaker r person having charge of corpse) ( ,or dispos�gf,(st howl) y
Dated. _ ...� 19 p '`gn ) ��p '_4 Local Registrar
This Permit is sufficient for the Removal (anti nterment or Cremation) of a body to ggs�nny part of the
State (subject to local cemetery or other regulations).!inlets removal is by common carrier, irVsvhich case a
Transit Permit(VS No.62)is required. li
I
1
10-1-20-T5.000(21-1925)
ENDORSEMENT OF SEXTON OR PERSON IS
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
,
Date of .tom'-r- ,......... ..rg...�
�d `e^G.� or enema ion)
(Signed) �„ �,, ,,
(Person �� 1, , /
in charge)..._._ I , +G�. .4,,e49 ._._
(Name of Cem Crematorium,etc.)
Person in charge must return this Permit to Registrar of his District witlda
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.
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 i
-c he district in which the death occurred and obtain a burial or removal `i
`- _.„ lisoosition of the body. * * * The undertaker shall
_...._.__._.. .. • ..c..h.,.dal. before "t
l
2., ','
f
I • wu.....
• of the place of uu..A...
§ 380. Duties of undertakers; interment within the state. If the .,,,.er-
' meat,or other disposition of the body is to be made within the state,the word li
-
I 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 ij
been filed with him, as required by law,permission is granted to inter,remove l
or dispose otherwise of the body, stating the name, age, sex,cause of death, j
and other necessary details upon the form prescribed by the commissioner of
health.
§ 881. 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 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 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
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.
Off'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