Budd, Almira 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 To
Village, or City) in wh' h the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF OF
DEATH, LEGIRTEN IN DURABLE BLACK INK Town Registered No...
Noft �TOGJ Village ratoga
Dist. County S .�s��/ City -, tdDrInz ((AA•yy,,
4 Is
(If city, give t et dills )
Name raceased • - i Veteran
l Single, married, widowed, (lf vet divorced
°c�u°`)
Sex.... ... .iieefor....7� divorced (write word pat / /••••
Age Years j Months s Birth lac .... ....
Cause of Death .�i� ... . . .. .... � _
Certificate was signed by "
Address AO � •••
Place of Burl. . T oval ..
(If body le to •r y.- •', .ar„` �
Cemetery.. Date of Burial. .. 19..
(If body ie to be emporarily held,till in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after carefiril exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISTACTOR AS REQUIRED BY LAW,
I have accepted the same for re 's ion, hove record it in my Local Record h the above stated;+e:istered
andNumber, nd on thy.,:: s,4er EREB GRA A PERMIT jc'4
:o ,.�Il__ I .4'.. .'. ,
...
the .. .. .. old temporarily and ... . � ...... .the o y.
(Under r or n h n charge .). (Int ,remove,or th• w1< .o of e h ])
Dated .... 779.. ....' (Signed) r.
'"'... -
Loca j; gistrar
is Permit s sufficient for the Removal (and Interment or Cremation) of a body to any p 'fit to local
:emetery or other regulations),unless removal is by common carrier, in which case a Transit Permit ( o. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERM TS FOR
REMATIONS ARE MA Dig '
Date of... . • � 0 �e (/ 19.. j
terJrtent or . j�l
(Person
in charge ...,.4 "—el i�1f eGn,e✓ ,I. ... .
(Name of C , ery, Cr - ;a11: • )
Person in charge must return 'his Permit to,R=•istrar of his District �klt in
SEVEN (7) DAYS from above date. If no per .n is in charge, the UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit
the words "No person in charge," and FILE PERMIT W THIN 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 person
whose death occurs in this state or which shall be found dead therein shall not be
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
from or into any registration district,or be temporarily held pending further disposition
more than seventy-two hours after death unless a permit for burial, removal, or other
disposition thereof shall have been properly issued by the registr r of vital statistics of
the registration district in which the death occurred or the body was found. No such
burial or removal permit shall be issued by any registrar until, herever practicable, a
complete and satisfactory certificate of death has been filed with im as heretofore pro-
vidrsi; provided that when a dead body is transported from outs e of the state into a
registration district in this state for burial, the transit or removal permit issued in
ac&'rdance with•the law and health regulations of the place whe,-e the death occurred
sh:i" be given the same force and effect as the burial permit herein provided for. No
rr:gifstrar of vital statistics shall receive any fee for the issuance''of burial or removal
permits under this act other than the compensation provided in this article.* Provided,
however, that the commissioner of health shall have power to romulgate rules with
reference to the removal of bodies of persons whose deaths occ r on trains, boats or
other carriers engaged in the transportation of persons within this state. (Am'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
:finless 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 over his
signature,and shall return all permits so endorsed to the registrar+of his district within
seven days from the date of interment or cremation. le shall keep a record of all bodies
nterred or otherwise disposed of on the premises un er his charge, in each case stating
:he name of each deceased person, place of death,d to of burial y T disposal,and name
find 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
fi body in a cemetery or burial ground having no person in charge, shall sign the burial
or removal permit, giving the date of burial, and shall write across the face of the
)ermit the words "No person in charge," and file the burial or removal permit within
three clays with the registrar of the district in which the cemetery is located.
fre SEXTONS and UNDERTAKERS violating the law relative to the return of
)ermits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
CHAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.
:.oval Registrars, are required, under penalty, to report violations thereof.