Wooley, Clark NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sw-This permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Regiatra.
tion District(Town Village,or City)in which the death after after the FILING and acceptance of a COX.
RECT AND COMPLETE CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No. 1.....,. R • ed No. ___________--
county
Warren __._ _ _ ,, 0._—.Warren _-_ -..-_._. Date of Death.- -._ I .4
Town,Vi1-Cit}y�, I . Glens ell
lage,or City' ` '! --fit-- seafd Age-T ---Yrs. Color._... —....
(If city,give street: , (Or .) Ij
Cause of Death.. ,...._e..i.:._� ..., _ __ _ �► ?.GG��/�
Place of Burial emoval)._ I / , . . _ Y _
Cemetery.._. 4t4Ad - - — Date of urial.. __. ._. _..i9 _
i,4 Certificate of Death of.-._-iie, .,.i 4.84 Il —— —
(Give full name of deceased)
having been presented to me containing the above stated particulars and, after careful examination
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I have ac- .ted the same for registration,have recorded it in my Local Record with
the eve 1, - gister . .. . - ,and on the basis it . . I. =Y ,N ERMIT
..- . (Address)
the...... to t, •.e.••
�(' • of having charge ) In M a. rt • j,,
a��y� ( .4. eta
Dated..... _ ... 1941 (Signed)-- ` _ •-
Local Registrar
is 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
Transit Permit(VS No.62)is required.
ENDORSEMENT OF SE*TON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Data of _ - s._..,ram „......rgailijle
star " ma'on)
(Signed) . ....._ . ... ........
(Person
is aharg.)._✓-,±'�'�S �aille'I Mr
Name raetteryi C tomun,etc.),
Person in charge must return this t to Registrar of Ws District within
SEVEN(7)DAYS from' above;date. If no is in charges theUIDER-
TAKER MOST SIGN ABOVE STATE write across the face of the Permit
the words"No person-is charge.r and'_ PERMIT WITHIN THREE(3)
DAYS with Registrar of*District In'which meters is located.
EXTRACTS OF THE VI STATISTICS LAW
$ era Duty of undertaker. In h case the undertaker, or person
having charge of the corpse,shall file the tificate of death with the registrar
of the district in which the death o and obtain a burial or removal
permit prior to any'disposition of the . • * * 'The undertaker shall
deliver the burial permit to the person in' ate*of the place of burial,before
interring or otherwise disposingof the ; or shall attach the removal
permit to the box containing e corpse," lien shipped by any transportation
tcompany; said permit to accompany #co to its destination,where if
':al Novi*York.,it+riludi# �vered to the,person in charge
¢'88AI. Duties of undertskere; in t within the state. If the inter•
most or other disposition of the body is be made within the state,the word-
leg,of the burial or removal permit ma ;.be limited to a statement by the
registrar,and.over his signature thata sa aatory certificate of death,having
been filed with him,as required by law, ion is granted to inter remove
or dispose otherwise of the body,stating'he name,age,sex,'cause of death
and other necessary details upon the forte'prescribed by the Commissioner of
health.
f 881. Interments. No perms in ge of any premises on which
interments or cremations are made shall' or permit the interment or other
disposition of any body,unless it is ied by a burial,cremation or
transit permit,as herein provided. Such shall endorse upon the permit,
the date of interment,or cremation over. is signature,and shall return all
permits so endorsed to the registrar of his- within seven.days from'the
date of interment or He shall p a record of all bodies interred
or otherwise disposedof on the premises his charge,in each case stating
the name of eaceased parson place ,death, date of burial or disposal,
• name and address of the undertaker; ich record shall at all tunas be
open to official inspection; ided that undertaker or p Wing
charge of the corpse,when pt sag a bodl in a cemetery or k'ground
having no person in:charge; sign the burial or removal perm I giving
the date of burial,and shall to across t face of the permit the words No
person in charge,"and file VIM or re val permit within three days with
the registrar of the district in which the tery is located.
Igir SEXTONS and UNDERTAKERS latinng the law relative to the re►
turn of tosnitits are liable to a penalty of T LESS THAW FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS R THE FIRST OFFEMSE. t.
�d taw wilt be entered. Local Negistesrs,ant required,under vomit",to report
violations thereof.