Bovee, Frank Form .-s. 61. NEW YORK STATE DEPARTMENT OF HEALTH •
OFFICIAL BURIAL (OR REMOVAL) PERMIT
i 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 01
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.._ l,Z
Dist. No. . .z. County Town
City
••• ••••• .
r�• - (I Y f cit , give street address)
Name of deceased .- V24f-41/S,����- /r ¢�e€-•-
` � � ' Single, married, widowed, /� •
Sex // Color or divorced (write the word), h,GG!4! ,C�lr Date of I) :nth.../ / 19
Age CR Years � Months 2.,7 Days . Birthplace •q„",60 ,, i
Cause of Death..t-'-ietat -.././laia(!...�ca-r.42C, e,�
G , - . ." - •
.. . .. .
Certificate was signed by... .. - / NiI.D.
Address ` i)* -a
Place of Burial (or Removal) -ti /� ..,....
(if body is to be temporarily held, fill in space later)
Cemetery.....' - a.....D-a-e-Ae Date of Burial / /2 19
(If body is to be temporarily held,fill 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 be COMPLETE, CORRECT. AND SATISFACTORY AS REQUIRED 3V LAW.
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Numberw and 7�don the basis thereof I HEREBY GRANT A PERMITto ' _74.--e-e--.
(Nam Address)
the to hold temporarily and the body.
(Undertake 'r//pe�errson having charge
/ofcorpse) (Inter, remove,or oth rwi ls'ose of[state howl)
•• i�� / 19 (Signed,} ... .. . .. ...57 .R�K_e____
Dated.....1 ....
• -.Towel 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 removal is by common carrier. i.. which CA AA n Taman:it Par..., /VC ht-. a91 ;. _e,...._va
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE Of
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 1041 1.7 19.n
(Int nt or eret tion)
(Signed) fd\L°aVY -GL�.. .........
•
(Person ry�
in charge) lLl ... .Jam ... _. 'rent ......
... �. ... ... ........... ........
(Name of Cemetery, t'remunrn,n, 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 UNDEf
TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Perm
the words "No person in charge," and FiLE PERMIT WTTHIN 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 pers(
whose death occurs in this state or which ;hall be found dead therein shall riot 1
interred, deposited in a vault or tomb, cremated or otherwise disp,:sed of or remor<
from or into any registration district,or be temporarily held pending further dispositic
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 c
the registration district in which the death occurred or the body was found. No suc
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 prt
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 i
accordance with the law and health regulations of the,place where the death occurre
shall be given the same force and effect as the burial permit herein provided for. N
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 promulkate 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. (Am'd
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 pr removal permit prior to any dispositio
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 sha
attach the removal permit to the box containing the corpse, when shipped by any tram
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 bud
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 hodi(
interred or otherwise disposed of on the premises under his charge, in each case statin
the name of each deceased person, place of death, date of burial or disposal,and Hann
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 burit
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 withi
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 a
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