Berman, Maurice orm VS.6l. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
or 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, LE LY WRITTEN IN DURABLE BLACK INK. Registered No.
Q
Dist. No County.. .... alf Villas, .. . .. .TEMPOnt ^. 14a'�il�
or City � If city,give address) •
Name of deceased , .
Sexk �� /� "! Single, married widowed, 1
l2 .Colora or divorced (write the word . . . .. . Date of ea . ... ....1 191T G
Age , .¢..L., Year ... // Mo•"_s, l D ys Birthpl� act ... ...n194 .
Cause of Death .•... ... .. ,. , /.,. ,r- r .... . . ... .. .
Certificate was signed by .-�`�" •� �• r M.D.
i�li' •.
AT
Address 4 . ..../i '. /. . . . Y/ )7.4
Place of Burial (or Removal)..../..-:�T.ir• • I -l_ a-41- . ..:I '^ • )2•.•• '
(If body is to be temp drily held,fill in 1 r),
Cemetery -- ¢/ ' a Date of Burial..!. a..? 19. 1p
(If body is to be temporarily held,fill in spa ater) '
The Certificate of Death containing tirc above stated particulars, 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 registration, have recorded it in my Local Record with the above stated Registered
N ,ber, and oche basis they f J.HEREBYsj GRANT A PERMIT /�'�/] f`yn
t,A.... /1 ... .. .( e -✓G✓•.. .... .. .. .. ..... .. dress) ..6.f..'.,,('� ,
e ......a.. . . to hold temporarily and .. ���J!! the body.
ndertaker or person having charge of corpse) a e,or otherwise disoos of [state howl)
Dated� ......0.9 19.. 7 (Signed)
Local Regis
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any paliie ject 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 OP PERSON IN CHARGE OF
PREMISES ON WHICH !INTERMENTS OR
CREMATIONS ARE MADE
Date of �cJ t7.7 19�f
nfrment or ere at:on)
(Signed) ' ?��G%�CJrfQ'-� n °}
(Person )
in charge) e, •
(Name of Cemetery, Cre atorium, etc.) v
Person in charge must return this Pern't to Registrar If his District withi.
SEVEN (7) DAYS from above date. If no person is in charge, the UNDER
TAKER MUST SIGN ABOVE STATEMENT, 'trite across the face of the Permi
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 tor burial or removal of a-ead bodies. The body of any perso
whose death oct;urs in this state it which sh be fond deadf therein shall not b
ltll.l LCu;�1Gj1VSi L.`ll Ilt .t c6UIL Ut l l 14, 1.1 tlllalR.'Vi VL116 13C lliStaViC$:t-"Vt-'! '• -'
from or into any registration district,or be temporarily lead pending further dispositio
more than seventy-two hours after death unless a permi1t for burial, removal, or othe
disposition thereof shall have been properly issued by the registrar of vital statistics o
the registration district in which the death occurred oi'"the body was found. No sue
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 pie
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 ill
accordance with the law and health regulations of the'place where the death occurred
shall be given the same force and effect as the burial permit herein provided for. Ni
registrar of vital statistics shall receive any fee for the issuance of burial or remova
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 wit
reference to the removal of bodies of persons whose deaths occur on trains, boats o
other carriers engaged in the transportation of persons within this state. (Am'd b;
L. 1932,ch.267.)
•See sectio. 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 ii
which the death occurred and obtain a burial or removal permit prior to any dispositioi
of the body. ***The undertaker shall deliver the burial permit to the person in charg
of the place of burial, before interring or otherwise disposing of the body; or shal
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 i
red,tn ttlg nersnn p_charge o f the plac
of burial. ,
§ 381. Interments. No person in charged' f any premises on which interments o
cremations are made shall inter or permit the ii4ermerit or other disposition of any hod:
unless it is accompanied by a burial, cremation, or transit permit, as herein provided
Such person shall endorse upon the permit,the(late of interment,or cremation over hi
signature, and shall return all permits so endorsed to the registrar of his district withii
seven days from the date of interment or cremation. He shall keep a record of all bodie
interred or otherwise disposed of on the pre rises under his charge, in each case stating
the name of each deceased person, place of d,ath, 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 buria
or removal permit, giving the date of burial, and shall write across the face of th,
permit the words "No person in charge," and file the burial or removal permit withii
three days with the registrar of the district in which the cemetery is located.
aa'SEXTONS and UNDERTAKERS violating the law relative to the return o
permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORI
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced
Local Registrars, are required, under penalty, to report violations thereof.