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Bacon, Glenroy Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tr 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 CERTTIIAAE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registere No... ... . Villity � •--�-� Dist. I�'O �� •County 7/Z401.4.e4er.";,, Or C1 (If city, give t address) Name of deceased . ...r..... . ..... Veter Sln le arried, widowed, (If v term, give me of Wu) S .•Colon or div rced (write a word Date o ath 97'b. Age rl . ,....Years Months ,! U ays es Bi ac .. `A7 Cause of Death Certificate was si d M.D. Address. • Place of Burial (or Remov (If body 1s to b t or a pace late.),.,...... �/ Cemetery.. Date of B al...y x-i eext_A � 19�7' (If body is t be temporarily held, fill in space later) The Certificate of Death c.)ntaining the above stated particulars, having been presented to me, after careful exami- nation, the same api't-•Irt g too 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 Number, on the b s t f } GRANT A PERMIT _Art.00.....lailie, to �f the .. . . . to hold temporarily thebody. , (Una, rt or person ng charge of worse) (Inter em9y�e or wise die se of[state bow]) Dated ... ,.7a9..�5/6 (Signed)......... //c/.. oh - Lora egistrar This Permit is sufficient for the Removal (and interment or Creme on) of a body to any part of the State (subject to local -•eterq or other regulations), unless removal 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 CREMATIONS ARE MADE Date of ,.7.1.1..Y..- e. ...3. 19 L( (1n' 'r -: .+tiun) (Signed).......... .. ... .0. . _ Ot/L...•_... ._.._.. (Person ) .. rli A/n^,�" .. .>/�'��Yt/� �Lil� �j�i►... .. ..�j' /�/� .._... in charge) .. :..�4.ivK �• "`� (Nam of Cemetery, Crenmati,Ium, et,_., Person in charge must return 'his Permit to Registrar of his District within SEVEN (7) DAYS from above date. If n. person ,s in charge. the UNDER- TAKER MUST SIGN ABOVE STATEMENT. write acr,"ss the face of tha Permit the words "No person in charge," and ILE PERM'I WITHIN THREE (3) DAYS with Registrar of District in which c metery is ]:sated. EXTRACTS OF THE VIT L STATISTICS 'LAW § 375. Permits for burial or removal dead bodies. The body of any person whose death occurs in this state or which s all be found dead therein shall not be interred, deposited in a vault or tomb, crema d or otherwise disposed of or removed from or into any registration district,or be to orarily held pending further disposition more than seventy-two hours after death unle a permit for burial, removal, or other disposition thereof shall have been properly is ucd by the registrar of vital statistics of the registration district in which the death oc, urred or the body was found. No such burial or removal permit shall be issued by al registrar until, wherever practicable, a complete and satisfactory certificate of death i as 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,ithe transit or removal permit issued in accordance with the law and health regulatiotis of the place where the death occurred shall be given the same force and effect as thk burial permit herein provided for. No registrar of vital statistics shall receive any,-€peg for the issuance of burial or removal permits under o this act other than the compensation provided in this article.* Provided,,t 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. (Arn'd by, L. 1932, ch.267.) •See section 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 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 cremations are made shall inter or permit the interment or other disposition of any body unless it is accompanied'by a burial, cremation or transit permit, as herein provided. Such person shall endorse upon the permit,the date of interment,or cremation aver his signature,and shall return all permits so endorsed to the registrar of his district within seven days from the date of interment or cremati'n. He shall keep a record of all bodies interred or otherwise disposed of on the premis i,s 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 record sh 11 at all times be open to official inspec-. tion;provided that the undertaker or person ha ing charge of the corpse,when burying a body in a cemetery or burial ground having n' person in charge, shall sign the burial or removal permit, giving the date of burial, rid shall write across the face of the permit the words "No person in charge," and a the burial or removal permit within three days with the registrar of the district in which the cemetery is located. gt SEXTONS and UNDERTAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. • _r n__n_._-__ ___ _...........t .....f.. ...nn Ito_ to renart violations thereof.