Gifford, Hazel 0 26-=9-10,000 (17-8079)
TRANSIT PERMIT
Form VS No.62
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
tar A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany each
dead body transported by a common Barrier.—Rule I.
UNDERTAKER'S CERTIFICATE
u
a
4 11 lbereby Certifg that the accompanying dead body of Haze_1___I.aGny Gifford Q
a Glens.___Falls,N.Y. who died in the Town of Marcy
(City,Viii )
'' County of Cx,eida , State of New York,on �� 21 19.31, Sex Female ,
x Color or race White , Age 32 years 9 months 11 days,and Cause of
Death C_hr_Qnic._.myO.Ca d:it s has been prepared for transportation
strictly in accordance with RULE 2as printed with this blank. Date of shipment.._..MttCh•--22
-fl (srrtg,,l°�} , x Impress ;Point of
a1931.;Route of shipment 4� 11�t1 .—
shipment Uti ea,N.Y. •Point of destination_ ._ .. __a�.-Q-ns____Fa11 }----�•.-Y.....
3 (Signature of Undertaker) t i G a (�
>, Dated March 22 �9 31 Address
a
PERMIT OF LOCAL REGISTRAR 62
h Dist. No. 3211 Registered No.
Date of issuance March 22 �9 31
A satisfactory Certificate of Death for above decedent having been filed and recorded in my office, PERMISSION IS
HEREBY GRANTED FOR THE REMOVAL AND SHIPMENT OFT E Y.i�
"� Deputy
Signature of Local Registrar) �
Local Registrar of the City of Utica , County of Oneida
(City, Village or Town) Utica State Hospital
State of New York 4
Nr Onl je Local Registrar (Deputy or Subregistrar) cart issue a Burial, Removal or Transxl Permit
_c1 j*—
nate-Detach here and give part above to escort or attach to waybill if shipped by expres0
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of was �
. 6' '-; <
(Interment or cremation) rg
(Signed)
e..
Person in charge of _ __ _ _—�j V.�.....-----1 f _ ,,
(Name of Cemetery, Crematorium, etc.)
Person in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from above date. If no person
is in charge,the UNDERTAKER MUST SIGN ABOVE STATEMENT,write across the face of the Permit the words"No person in
charge," and FILE PERMIT WITHIN THREE (3) DAYS with Registrar of District in which cemetery is located.
EXTRACTS FROM VITAL STATISTICS LAW
§ 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 land 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 other-
wise disposing of the body;or shall attach the removal permit to the box containing the corpse, when shipped by any transportation
company; said permit to accompany said 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.
§ 380. Duties of undertakers;interment within the state. I`the interment,or other disposition of the body is to be made within
the state, the wording of the burial or removal permit may be limited to a statement by the registrar, and over his signature,that a
satisfactory certificate of death,having been filed with him,as required by law,permission is granted to inter,remove or dispose other-
wise of the body,stating the name,age,sex,cause of death,and other necessary details upon the form prescribed by the commissioner
of health.
§ 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, 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 all 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 burial or disposal, and name and address of the undertaker;which record shall at all,times be open to official inspection, provided
that the undertaker or person having charge of the corpse, when urying a body in a cemetery or burial ground having no person in
charge, shall sign the burial or removal permit, giving the date c{, burial, and shall write across the face of the permit the words, "No
person in charge,"and file the burial or removal permit within thine days with the registrar of the district in which the cemetery is
located.
SEXTONS and UNDERTAKERS violating the law relativs to the return of permits are liable to a penalty of NOT LESS THAN
FIVE DOLLARS l R MORE THAN FIFTY DOLLARS FOR TEE FIRST OFFENSE. The law will be enforced. Local Registrars
are required,undet penalty,to report violations thereof.
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