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Gilpatrick, Henry Form VS.St NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tar This 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 CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN URABLE BLACK INK. gown Regi ered No. .... Village Dist. NT .4 .Count .. f city,give stree address) Name of deceased... . . . . .. . .. '.....,/... ... Veteran 1)p Singl '" arried widowed �' f veteran, give ame of War) Sexv • Color., .,.... . r di reed writ the worn, Date of 19. Age .p7 Years... Months ...�.—:..Causeeath . .. .. . ... ... ...... . .:. ... . . Certificate was signed by' .r..` ... . - .. . .. .. ... .. M.D. Address - ' Place of Bu • (or Re val) (If body is to orartly eld,•ftll Ins ac r) f Cemetery..._.... ..� Date of Buria .. 19. (If body is to be temporarily held,fill in space later) The Certificate of Death containing the above stated articulars, having been presented to me, after careful exami- nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for r`.'. i atio v record fit in my Local ecord w' the a ted Registered Numb�'Cand on the b is er-,- I GRAN ►1/ PERMIT to '�l .... . .��s'.e..... .. »... ... ' N (Address) the t to hold tempora 'ly aud.... y,�yt..th body. Arta r or p chars c ) er remove or otherwl one of[sta eeJGbw] Date .. . ... 19.7 (Signed)./.. .. Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) o a y to any part of the State (subject to local cemetery or other regulations),unless removal is by common carrier, in which cases Transit Permit (VS No. 62) is required. ENDORSEMENT OF SEXTON OR PERSON IN CHARGE 01 PREMISES ON WHICH INTERMENTS OR _ CREMATIONS AR_EIIADE Date of - (Interment or (Signed ... • A ..... (Person in charge .. 2 (Name of Cemevtery, Cremators etc.) Person in charge must return this Permit to Registrar of his District with SEVEN (7) DAYS from above date. If no person is in charge, the UNDEI TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Perm the words "No person in charge," and FILE PERMIT WITHIN THREE (2 DAYS with Registrar of District in which cemetery is located. EXTRACTS OF THE VITAL STATISTICS LAW § 375. Permits for burial or removal of dead bodies. The body of any perst whose death occurs in this state or which shall be found dead therein shall not I interred, deposited in a vault or tomb, cremated or otherwise disposed of or removi from or into any registration district,or be temporarily held pending further dispositii more than seventy-two hours after death unless a permit for burial, removal, or oth disposition thereof shall have been properly issued by the registrar of vital statistics the registration district in which the death occurred or the body was found. No sus burial or removal permit shall be issued by any registrar until, wherever practicable, complete and satisfactory certificate of death has been filed with him as heretofore pr vided; provided that when a dead body is transported from outside of the state into registration district in this state for burial, the transit or removal permit issued accordance with the law and health regulations of the place where the death occurrt shall be given the same force and effect as the burial permit herein provided for. Is registrar of vital statistics shall receive any fee for the issuance of burial or retuov permits under this act other than the compensation provided in this article.` Provide however, that the commissioner of health shall have power to promulgate rules wi reference to the removal of bodies of persons whose deaths occur on trains, boats other carriers engaged in the transportation of persons within this state. (Am'd I L. 1932,ch.267.) •See section 390. § 379. Duties of undertaker. In each case the undertaker, or person havir charge of the corpse,shall file the certificate of death with the registrar of the district which the death occurred and obtain a burial or removal permit prior to any dispositir of the body. *** The undertaker shall deliver the burial permit to the person in chari of the place of burial, before interring or otherwise disposing of the body; or sha attach the removal permit to the box containing the corpse, when shipped by any tran portation company; said permit to accompany the corpse to its destination, where within the state of New York,it shall be delivered to the person in charge of the play of burial. § 381. Interments. No person in charge of any premises on which interments cremations are made shall inter or permit the interment or other disposition of any bor unless it is accompanied by a burial, cremation or transit permit, as herein provide Such person shall endorse upon the permit,the date of interment, or cremation over h signature,and shall return all permits so endorsed to the registrar of his district with seven days from the date of interment or cremation. He shall keep a record of all bodi interred or otherwise disposed of on the premises under his charge, in each case static the name of each deceased person, place of death,date of burial or disposal,and nan and address of the undertaker; which record shall at all times be open to official inspe tion;provided that the undertaker or person laving charge of the corpse,when buryir a body in a cemetery or burial ground having no person in charge, shall sign the burl or removal permit, giving the date of burial, and shall write across the face of tl permit the words "No person in charge," and file the burial or removal permit with three days with the registrar of the district in which the cemetery is located. 8 SEXTONS and UNDERTAKERS violating the law relative to the return permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR. MOIi THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforce.