Gibbons, Carrie ;Form S.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Tows
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE O
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
Town �'Z1L -�
Dist. No�.7,�.,(�.County.�
—� (If city,blfe a street address)
Name of deceased O lil -2 ,r... .......
Single,.married widowed, ,, '' nn ` !/�
Sett olorr diuofeed•(write the word)..C�/�L . .... Date of Deatl . � � 19.'i'!F
Age 43 Year onths. ....ee Days Birthplace7.a„r'�. ....h...
Cause of Death — �ofx-e-i-i'ra2-4Y-L4sei-.,
_Certificate was si ned b �� _..
g Y C�Ir�Ct-R. n►..1. .�? .... 'n M.D
Address /lu
Place of Burial (or Removal).. ,,Ziii' , h a V .
. . . ... . ..... .. . .
(lf body is to- a orar_ilLheld,fily�n space later
Cemetery.. w ,�i.......; Date of Burial... e .. . /e 19,4/4
(If body Is to be temporarily held. 1111 In space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami.
nation, the same appearing to he 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 Registerec
N l':er, and on the bad is ther f HER�NT A PERMIT
the...il , (./ 1 to hold temporarily and. 7.44 the body
( - derta r or prson having charge sn
,eorphe) nter,remove,or o he tose of[state how))
Dated.. c 191 .. (Signed) -4,-,----'
Loos Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to loco;
cemetery or other regulations), unless removal is by common carrier. ;.. ..,6;.4. s.. . Tv...... P ....a (VC N.. a9\ :. ......:....i
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE 01
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
C1..Date of i 1 Q 19.1,/4
(Intcrenti or ere ation
(Signed) ...... .. . ►.
(Person _— _ �[ M
in charger ... .�/�Cf7o....... 0M't4�? /Y..��
(Name of Cemetery, Crem torium, 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 (:
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 persi
whose death occurs in this state or which ,hail be found dead therein sjiall not
interred, deposited in a vault or tomb, cremated or otherwise disposed of 8r remov,
'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 sut
burial or removal permit shall be issued by any registrar until, wherever practicable,
complete and satisfactory certificate of death has been tiled 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 occurrc
shall be given the same force and effect as the burial permit herein provided for. Ir
registrar of vital statistics shall receive any fee for the issuance of burial or--remov
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 wit
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. (Ain'd t
L. 1932,ch.267.)
•See section 390.
§ 379. Duties of undertaker. In each case the undertaker, or person havin
charge of the corpse,shall file the certificate of death with the registrar of the district i
which the death occurred and obtain a burial or removal permit prior to any dispositic
of the body.***The undertaker shall deliver the burial permit to the person in charti
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 trans
portation company; said permit to accompany the corpse to its destination, where i
within the state of New York, it shall be delivered to the person in charge of the plat
of burial. .
§381. Interments. No person in charge of any premises on which interments c
cremations are made shall inter or permit the interment or other disposition of any bod
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 hi
signature,and shall return all permits so endorsed to the registrar of his district withi
seven days from the date of interment or cremation. He shall keep a record of all bodic
interred or otherwise disposed of on the premises under his charge, in each caste statin,
the name of each deceased person, place of death, date of burial or disposal,and nam
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,buryin;
a body in a cemetery or burial ground having no person in charge, shall sign the burin
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.
it SEXTONS and UNDERTAKERS violating the law relative to the return o
permits are liable to a penalty of NOT I.ESS THAN FIVE DOLLARS NOR MORI
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced
Local Registrars, are reauired. under nen*lty. !n rnnr,.F y;ni t:..... EL.