Adams, Nellie torm Vs.61. NEW YORK STATE' DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t 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 CERTIFII,CA''E OF
DEATH, LEGIBLY WRITTEN IN DL'i2AB ACK INK. �"-' '/���///�-1 �egisteredzN�o......�,��..i
Dist. No : County [ ��%� v '"
(If city,give street address
Name of ceased ..
i;lt;ie, married, widowed, ,
Sex.... ..,. .. ..Color ,,,
li�,orce;l (write t e wor .. ate of �at$�... . .� 19.
Age .. Years... ..,..Mon L .4 Days Birthplace s/ l a -�-
Cause of Di'
7eath
Certificate was signed b- /.� , �.. M.D.
Address ... .. ,
Place of Burial (or Re ,d) -. ... .. ;...
(If body is to be temporar eld,fill in space later) ,/
Cemetery Date of Burial ` 19J`J
(If body is to be temp rarely 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 COMPL TE, CORRECT, AND SATISFACTORY ;'\S REQUIRED 1'\ L MAT,
I have accepted the same fo registry 'on, ve rded it in my Local r ith the ab a tat Registered
Number, an 'on the basis er ANT A PERMIT
/ i ( ss
the r s .... . ......... :..to hold temporarily and .. . .. ........... ... . the bc.,.i .
(tinde er o erson vi rge o orpse) (I r e,or other •: ' a of state . ,)
Dated 19 (Signed).... . . .. .. .. �.
This Permit is sufficient for the Re oval ae gist r
(and Interment or Cremation) of a body to any part of the State (su jest 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 OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE NADE
ace of .. Lf ,i:7- V 19..0 7
nterment or�•.rrn tine) •
;Signed)..... '
(Person • /�
n charge) ., "_ .r.t..4-4+--- 41f7
(Name of Cemetery, Cremar.,riurn, etc.
Person in charge must return this Permit to Registrar of his District within
;EVEN (7) DAYS from above date. If no person is in charge, the UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit
.he words "No person in charge," and FILE PERMIT WITHIN THREE (3)
SAYS 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
a hose death occurs in this state or which shall be found dead therein shall not be
`hterred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
`rom or into any registration district,or be temporarily held pending further disposition
pore than seventy-two hours after death unless a permit for burial, removal, or other
lisposition thereof shall have been properly issued by the registrar of vital statistics of
tie registration district in which the death occurred or the body was found. No such
atrial or removal permit shall be issued by any registrar until, wherever practicable, a
!omplete and satisfactory certificate of death has been filed with him as heretofore pro-
Tided; provided that when a dead body is transported from outside of the state into a
•egistration district in this state for burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
,hall be given the same force and effect as the burial permit herein provided for. No
registrar of vital statistics shall receive any fee for the issuance of Lnriil or removal
ier,•niits under this act other than the compensation provided in this article.* Provided,
iowever, that the commissioner of health shall have power to promulgate rules with
•eference to the removal of bodies of persons whose deaths occur on trains, boats or
ither carriers engaged in the transportation of persons within this state. (Am'd by
1932,ch.267.)
•See section 390.
§ 379. Duties of undertaker. In each case the undertaker, or person having
:harge 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
>f the body.***The undertaker shall deliver the burial permit to the person in charge
if 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-
>ortation 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
if burial.
§ 381. Interments. No person in charge of any premises on which interments or
:remations are made shall inter or permit the interment or other disposition of any body
mless it is accompanied by a burial, cremation or transit permit, as herein provided.
inch person shall endorse upon the permit, the(late of interment,or cremation over his
ignature,and shall return all permits so endorsed to the registrar of his district within
even days from the date of interment or cremation. Ile shall keep a record of all bodies
inured or otherwise disposed of on the premi es under his charge, in each case stating
he name of each deceased person, place of diath,date of burial or disposal,and name
lid address of the undertaker;which record shall at all times be open to official inspec-
ion; provided that the undertaker or person having charge of the corpse, when burying
body in a cemetery or burial ground having no person in charge, shall sign the burial
it removal permit, giving the date of burial, and shall write across the face of the
permit the words "No person in charge," and file the burial or removal permit within
hree days with the registrar of the district in which the cemetery is located.
St 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
HAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be en for ced.
.oral Rsoistrera_ Are renuirArl_ unrl•.r nenalfv fn rannrf .,inlntin..,. •6.....t