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Baker, Etta Form VS No.62. 9-25-41-10,000 (17-C244) TRANSIT PERMIT NEW YORK STATE DEPARTMENT OF HEALTH ALBANY A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany each dead body transported by a common carrier.—Regulation 1, subdivision 1. UNDERTAKER'S TIF TE 3 itterebp QLerttfp that the accompanying dead body of.. _..._.. ... _ '+ who died in the /fY -� fl°1 (CI illag:or Town) > ��-• `� fie+' . Cet. bi County of_h �. J�`.- , State of New York, o ex.. _ wig d"ow d l. u Color or ra _ .., Ag4-7.years_6 month 0 days, Birthplace.. .. ,and Cause of ^' Death _. _...._....._. _. _._._._..has been prepared for transportation -°-' is 'n a o a e ith R ulation 1, subdivision...._ ... .as printed with this blank. Certifica was si a by,_ �1 � r �.r %ems. i ....M.D., Addres ,,.._--241apeof shipmen�� � ..AS ..ti' 1 ... ...._• ute of shipme t ...___...... __... .... . ........ . ___ .__....._...._..._..._• Point of 3 ship n ...... ... . Point of destinatio _.. .... _. ..... .. _. ._.. }re _...r..._. .. : ..._. .___._. _ (Signature of Undertaker).._..... .. ... il Dated. ... .... /' 19. ' Address l� /. lying. w y . I `Cross out words not app p T. PERM OF LOCAL REGISTRAR Dist. No...Y �1 R 's red No....4`�.j'4��. ,y Date of issuance ~�' ' —19 v2 A satisfactory Certificate of Death for above decedent having n led and recorded in my o PERMISSION IS HERE- i --BY GRANTED FOR TH REMOVAL AND SHIPMENT OF B Y. -- (Signature of Lo egistrar _ ;C,ocal Registrar of th .... o .. _. ._. .. ty of _ _. ... .. . ... . .. ._ ... ....__.__ (City,Village or Town) _State of New York., , Only the Local Registrar (Deputy or Subregistrar) may issue a Burial, Removal or Transit Permit _ -, Detach here and give part above to escort or attach to waybill if shipped by express i t . ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH :INTERMENTS OR CREMATIONS ARE MADE • Date of .... _.._.... `' _ 1!._...r_was __ ..._......._( 592/4_.. _ _ 19__._../ , (Interment or Cae ienn ((( (Signed) - _ _._. . ._ ..._....._...._......_.... .. Person in charge of ....eferZe._.....Z ".y, (Name of Cemetery,Cat, etc. ` Person in charge must return this Permit to Registrar of his District w' n SEVEN (7) DAYS from above date.If no pe n 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 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 transportation 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. §380. Duties of undertakers; interment within the state. If 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 signa- ture, that a satisfactory certificate of death, having been filed with him, as required by law,permission is granted to inter, remove or dispose otherwise of the body, stating the name, age, sex, cause of death, and other necessary details upon the form pre- scribed 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 pro- vided. 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.shallkeep 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 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. I 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 THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be - _ enforced. Local Registrars are required, under penalty,to report violations thereof.