Snyder, Herman Form Vh. 61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
12r 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
DURABLE BLACK INK. ie
egiiestere No. '
-�4 N Count y G� � `T.et t
/A....e...i,
Dist. No }} —
r •ty (If city, give street address)
Na e of deceased . . . . _
/ ngle, marrie , wido d,
x olor.G(1�� ��-L�r. divorced (write th ord) .Date of pelqh / 19',I6
.. . .... .... . ... .
15.
e, s Months Day. Birthpla e.... ... ... �C/
Cause of Death.. �e • s . G;4
i
Certificate was sig
i
/.,, ` /
Address .�... .
Place of Btu ial Jr Removal) ... .... ..
(If body 1s to be t•.. :rily held,fill in _pa>:later) _//
Cemetery.. .... Date of Burialr....a7 19'`'4
.. .
(If body is to be temps-:rily held,fill in space later)
The Certificate` Death containing the above stated p iculars, having been pres ed to me, after careful exami-
nation, the sa e appearing to be COMPLETE, COR ECT, AND SATISFACT Y AS REQUIRED BY LAW,
I have accepted the same for re 'stration, have recorded it in my Loc Record with t e above sta ed Registered
Number d on the b�asjs the . .f I HE' B !ANT A PERMIT -' .
-1-.2..� ! A ;
-•:me) )
the / . ./ ! "� �6 to hold temporarily ( dregs, the body.
(.ndert, :2 .r pers,, havingss��arge gore) ( to emov otherwi snore of-Es e how])
Dated. .'. ' ' of.19.. . (' (Signed)
ti, r Local Re strar
his 1'ermit is sufficient for the Removal (and Interment or Cre ation) of a body to any pa of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
C E TIONS� ,ARE MpiDE
Date of _. ( 2r /v 7 19
Inter et r .re iau n)
(Signed) t
(Person
in charge) .. '� rig...Lady
(Name of Cemetery, -remrtorium, etc.)
Perso in charge must return this rmit to Registrar of his District within
SEVEN (7) DAYS from above date. no person is in charge, the UNDER-
TAKER MUST SIGN ABOVE STATE} T, write across the face of the Permit
the words."No person in--stberge,"`"an FILE PERMIT WITHIN THREE (3)
DAYS with Registrar of District in whic' cemetery is located.
EXTRACTS OF THE VI AL STATISTICS LAW
§ 375. Permits for burial or remove of dead bodies. The body of any person
whose death occurs in this state or whicl shall be found dead therein shall not be
interred, deposited in a vault or tomb, cr . sated or otherwise disposed of or removed
from or into any registration district, or be mporarily held pending further dispo,ition
more than seventy-two hours after death a less a permit for burial, removal, or other
disposition thereof shall have been properl ,issued by the registrar of vital statistics of
the registration district in which the death occurred or the body was found. No such
burial or removal permit shall be issued by any registrar until, wherever practicable, a
complete and satisfactory certificate of dea i has been filed with h'm as heretofore pro-
vided;
()inside provided that when a dead body istransported from u+side of the state into a
registration district in this state for buri.1, the t ansit or removal permit issued in
accordance with the law and health regula i,,ns of the place where the death occurred
shall be given the same force and effect a. the burial permit herein provided for. No
registrar of vital statistics shall receive�y fee for the issuan.e of burial or removal
periasitc- er this act-other.than_the rnm{ti gatipn,provided in this article.* Provided,
however, that the commissioner of health shall have power to promuh.,ate rules with
reference to the removal of bodies.of persons whose deaths occur on trains, boats or
other carriers engaged in the transportation of persons within this state. (Am'd by
L. 1932,ch 267.)
•See section 390.
§ 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 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.
§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, nr 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 inspec-
tion;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.
tom'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
11 AN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.
Local Registrars, are required, under penalty, to report violations thereof.