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Moore, Sarah Form VS No.61 NEW YORK STATE DEPARTMENT OF HEALTH ALBANY OFFICIAL BURIAL (OR REMOVAL) PERMIT iThis permit can be signed only by the Local Registrar(Deputy or Subregistrar) of the Primary Registration District(Town,Village,or City)in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CEI,TIEJAT//E OF DEATH,LEGIBLY WRITTEN IN DURABLE BLACK INK. / Dist No.. �. .L... Regis red No._._.l.....__... _.... County_ .ad Q DLf Death.._... ._ 19...2...� Town, Vil- `��� lage, or C Q... x Age.._.... . .... rrs. Colodr (If city give street address) ( Mos. / Cause of Death.......... _..._...._.._.........._.......... ali4 IRL�.l1"44 � ......... Place of Burial C !(// �j��� (or Removal).... �r��L t Qfe4j rate of By�7 "544• �19 2C A CERTIFICATE OF DEAT `.... _ _.._ fu ie of tr having been presented to me cont ming the above sta ed particulars, 1 , after careful examination, the same appearing to be COMPLETE, CORRECT,AND SATISFA TORY AS REQUIRED BY LAW, I have accepted the same for registration, have recorded it in my al Record with the above stet Re ister�e um r and on the basi hereof I HEREBY NT A PERMIT to // (Name Under the to _ ..__._the body. (Undert' er or perso a i c arge o corpse) (Inter, remove, o othe ise d' pose of [state how]) Dated _. __ 192 Signed)011111111: ........ .. ... Permit is sufficient for the Removal (and Interment or Crem n) of a odyto an art of State (subject to local cemetery or other regulations),unless removal is by common carrier, in which a a Transi Permit (VS 62)is required. a.— 10-20-27-73,000 (17-2623) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE er, Date of �' — /Q 19.. (I,nt t or emotion) ,�_ (Signed) _..... :.. �«C11tfi (Person /• "�/ ___ _.r► in charge).. L/ -------• ._ (Name of Cemetery, Cre torlum, etc.) f 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 UNDERTAKER 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 reg- istrar 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 re- moval permit to the box containing the corpse, when shipped by any trans- portation company; said permit to 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 he made within the state, the wording of the burial or removal permit may he 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 it charge of any premises on which inter- ments 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',.pejson shall endorse upon the permit, the date of interment or cremation i3 er his signature, and shall return all permits so endorsed to the r strar,'tf his district within seven days from the date of interment or eretyti. He shall keep a record of all bodies interred or otherwise disposer f on the premises under his charge,.in each case stating the name of each .person.o,place of death, date of burial or dieposal, and name and address of the undertaker; which record shall at all times be open to o81cialti'hspection; provided that the undertaker or person having charge of the corps*, 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. tar-SEXTONS and UNDERTAKERS violating the law relative to the return 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 he enforced. Local Registrars, are required, under penalty, to report violations thereof.