Gusten, Julia Form VS.8L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t4 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 CERTIF g OF
DEATH, LEGIBLY WRITTEN IN DU LE BLACK INK. ,Sawn Registered No.
7
/ Village
Dist. NoS / Count . .. ..,,/.fir i-- ---/%/J or Ci "
y''�L'� "S+ / '/1��� "`�� (If city, give street addres
Name of deceased -f- Veteran
Single, married, widowed, (II eran give name War)
Sex Color. or divorced (write th word). . . Date of eath...21. - // 19.. ..
Age 6 w Y,ers , Months ',�.. ....»...Days Birth la .
Cause of Death "- -A-7 /... . w -
Certificate was signed by.. ... . ... —_ M.D.
Address - a
Place of Burial (or emoval) *— .. .
(If body Is to be tempo ril eld 11 pace
Cemetery .....:. ...:...Date of Buri C;i ,., /,- 19 VC'
(I!body is to b e rarily held, fill in space later)
The Certificate of Death c,mtailling the ab lie stated particulars, having been presented to me, after careful exami-
nation, he same appearing to be COMPLETE. CORR ECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have cept the same fo registration, have recorded it in my Local or with the a s ted Registered
Number on .,•" sis" reo EREBY GRANT A PERMIT
•
to �„f '� �/ / .. dd es)
the -'`l .- .to hold temporarily a he body.
i. ertaker or peo h f barge rpse) ... a ve,or otrQ.
lse .a.oftate )
Dated -- ir..l9. (S gned).
• ,Roca' Registrar _ _
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 removed'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
CREMAT NHS ARE MADE ' (1
Date of .C.-L- lr- .:. :"--7(... i-'-19/ �-
X ( �.c�e�'t or re tiat
(Signed)...f�-:'.�1..._ ..1 ✓-. .✓! : .......(-.. -..-- a
(Person . p - �I
in charge) e Y'Na t. . '. r»'1
(Name of Centete{yl, C,rainatorium, 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.
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The body of any person
whose death occurs in this state or which shall be found dead therein shall not be
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
from or into any registration district,or be temporarily held pending further disposition
more than seventy-two hours after death unless a permit for burial, removal, or other
disposition thereof shall have been properly 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 death has been filed with him as heretofore pro-
vided; provided that when a dead body is transported from outside of the state into a
registration district in this state for burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
shah,,be givca the iratue-force and t"r.te •is the bariai permit herein provided tore No
registrar of vital statistics shall receive any fee for the issuance of burial or removal
permits under this act other than the compensation provided in this article.* Provided,
however, that the commissioner of health shall have power to promulgate 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. Iti 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
cr cmatir, ,c-axle-hal'•iri et:or t-'4 i i'�e' ;;t:: 0, C. 4;4pvsitior of aiiy•:n�Sy'
unless it is accompanied by a burial, cr ration or transit permit, as`herein provided.
Such person shall endorse upon the perm't,the date of interment,or cremation over his
signature,and shall return all permits sotndorsed 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 r 'Ord shall at all times be open to official inspec-
tion;provided that the undertaker or peon having charge of the corpse, when burying
a body in a cemetery or burial ground ving 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 charg 6 and file the burial or removal permit within
three clays with the registrar of the dist ict in which the cemetery is located.
ite SEXTONS and UNDERTAK RS violating the law relative to the return of
permits are liable to a penalty of N LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE IRST OFFENSE. The law will be enforced.
Lncal Re0;e4r5•11.a_ arw 11.en..;►arl_ nnrl.,« ..rnalio to w.r.r..ri .;..laN..... O1.r.�...0