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Smith, Allison _,-..,u-75,000(17-4362) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT fI 'This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra- tion District(Town,Village,or City)in which the death occurred after the FILING and acceptance of a COR- RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist No. .. - Registered No. No. County.... �� Date of Deatt�h-SJ1.<t� - I.L. 19..a 1 Town, Sex-�1A.... Age..-/_.1._.Yrs. Color W 4 (If city,give street address) (Or Mos.) Cause of Death •A- -; --: PIace of Burial (or Remov 1)__TrlAr't _ •( g.__(4,._a 0 Cemetery..__...---._.'_. ► Irate of Burial.._ / 19..5. Certificate of Death of I_----� , - '-�/ (Give full name of deceased) having been presented to n e containing the above stated particulars, and, after careful examination, the same appearing to 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 aboove stied Re iqed N ber,and on the basis thereof I HEREBY GRANT A PERMIT to..•- -• - 0.-�-5. • " C 1/.V- l/ - f'l (Name f undertaker) r Address) the 'U �A.,, 1 the body. l(rlinde taker or pergon having charge ofjco se) (Int LAor �rt s-e--tispo ate how])Dated_: 41 -1' 19 0 (Signed)- / *----->---'a1L1 Local 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, in which case a 1 , i 1 3EMENT OF' al-XTON OR PERSON IN 2CxE OF PREMISES ON WHICH INTER- / LENTS OR CREMr\TIONS ARE MADE,..,\ ' O� (Interment of cremation) .l� ge) ,' (Name of Cemetery,Crematorium,etc.) Person in charge must return this g'ermit to Registrar of his District within SVEN (7) DAIS from above date. i no person is in charge,the UNDER- :AKE31 MUST SIGN ABOVE STATEMENT,write across the face of the Permit the words a No person in charge,"and FILE PERMIT WITHIN THREE(3) DAYS with Registrar of District in which cemetery is located. EXTRACTS OF THE VITAL STATISTICS LAW § 379. Dutes 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 ii;which the death oce,irred and obtain a burial or removal permit prior to Any disposition of the,body. * * * The undertaker shall j deliver the buriAupermit t'the,person charge of the place of burial, before interring or otherwise disposing of the body; 3' shall attach the removal A ".iygr-,-«:.r <i-.. '-'"it ,.z-.. ,.....ts.. vy.-,,q ri.b, !iw..•i ti,n, company; said permit to accompany the corpse to iti des tion, whe'e iff within the state of New York,it shall be delivered to the rson in charge of the place of burial. §380. Duties of undertakers; interment within the stag. If the inter- ment,or other disposition of the ody is to be made within thli state,the word- ing of the burial or removal permit may be limited to a statement by the registrar,and over his signature,that a satisfactory certificate'hf death,having ,, been filed with him, as required by law,permission is grantedlto inter,remove or dispose otherwise of the body, stating the name, age, sex4 cause of death, i and other necessary details upon the fprm prescribed by the,commissioner of .Z health. § 381. Interments. No person in charge of any pr Rinses 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. Sofia 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. He shall keep a record of :Al bodies interred or otherwise disposed of on the premises under his charge,in each case stating the name of each deceased person,place of death, date of trial or disposal, and,name and address of the undertaker; which record shag at all times be , open to official inspection; provided that the undertaker r person having"S charge of the corpse,when burying a body in a cemetery;or burial ground having no person in charge;shall sign the burial or remedial permit, giving the date of burial,and shall write across the face of the pern$t the words "No person in charge,"and file the burial or renfoval permit within three days with the registrar of the district in which the cemetery is located. SEXTONS and UNDERTAKERS violating the law relative to the re- turn 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. Local Registrars,are required,unde 7 penalty,to report