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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.