DuFour, Joseph Form VS No.61. 1-20-30-75,000 (17-4362)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (DR REMOVAL) PERJvIIT
$This Permit can be signed only by the Local Registrar(Deputy or Subre istrar)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 boui Registered No
County..___�^Warren Date of eat I /
Town,Vil-l,.ity of Glens Falls, Sex_4._ Age _ Yrs. Color__ �.
lage,or City �"
(If city,give street ad Os i i (Or os.)
Cause of Death _use'
Place of Burial (or Removal)____...... (-y4='1 . __.
Cemetery _. 1 .� �•r-�gip-✓3' fr` _ - -Date of Burial � 19.41.,
Certificate of Death of / ( l./�(!l-(/L�'
( full itame of deceased)
having been presented to m ntaining e above stated particulars, and, after careful examination,
the same ap earing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I h e accepted the same f. registration,have recor d it in my Local Record with
the abov ated Register �: ,and. t - basis ther EREBY NT A ERMIT
(,,d
„elf 0
the V to __the body.
(tin er or p Waving.charg of pse) (Inte v o t er 's dis o e of[st )
Dated 1� �( 19.47 (Signed)-_--
t/ Local Regis rar
This P it
t 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
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
' Date of . ....19.......—
eqrar...1 or cremation)
(Signed) .---". ea...-a—e.......
(Person
in charge)
(Name of Cemetery,Crematorium,etc.)
Person in charge must return this Permit to Registrar of is District within
SEVEN (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
the words"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. Duties of undertaker. In each case the undertaker, or person
having charge of the corpse,shall file th0 certificate of death with the registrar
of the flistrict 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 Vt-iirwise disposing of thkebba or shall attach the removal
r,e--•,.. to a containing the corps slitopeoljay_any transportation
cornparot;;k t§permit to accomphny , corpse to its—d-estination, where if
within the state of New York,it shall be delivered to the person in charge
of the place of burial.
§ Duties of undertakers; interment within the state. If the inter.
meat,or
3
er disposition of the body is to be made within the state,the word-
ing of urial or removal permit may be limited to a statement by the
regist,ar, Ad over his signature,that a satisfactory certificate of death,having
been- *ith him, as required by law,permission is granted to inter,remove
or dispnae'otherwise 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 intermenpop,cremation. He shall keep a record of all bodies interred
or otharwisejosed 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 burying a 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 permit the words "No
person in charge,"and file the burial or removal permit within three days with
the registrar of the district in which the cemetery is located.
Mir SEXTONS and UNDERTAKERS violating the law relative to the re-
of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS
t MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
Will be enforced. Local Registrars,are required,under penalty,to report