Tarmey, Maxine Form VS No.61. 1-20-30-75,000(17-4362)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
mar-This Permit can be signed only by the Local cps ( ty or strar)of the Primary Radetra+
time District(Town Village or City)in which the a tli r flt the�FILINIG and ace•ptta of a COR»
RECT AND COMPLETE CERTIFICATE Or DRAT LEGIBLY WREN IN DURABLE BLA K INIL.
Dist No b801 Regi t,
County_ _ Warren �
rre --- Date of D th -...._-_--x
Town,Vil k City of--Glens Falls, set_ .e Yrs. Color li
lage,or City - r a (o.Mos.)
(If city,give street
Causeof Death.__ - _ •..•• ___________ __-___ _ ,_ -_____..
�j l/
Place of Burial(. • :�••Qyal)___ _ r
• AMA. _ t p Date of Burial.` '�.__. ...:".3'"`-.'
�_ Cemetery.._._...._ _ ______________________ J
Certificate of Death of__ _ . _.. .8___._3._._---_-_- - Y..,
(Give full name of deceased)
baying 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
LA" have accept-. e same for registration,have recorded it in my Local Record with
th vests* -e: Number, on t1 basis /j I H `A PERMIT
to__ s I -_ .r / , ___-- ,.w. `t',Oat) ,
the ,4// F�!s to_ j�, - *_ '
('id,*yr rso -ngc �) (In ,A f�jj �dyw ,v ,s. y.,.
Dated----... i (wed) _ ,__ :.
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation)of a body to any part of this
State (subject to local cemetery or other regulations), unless removal is by common carrier,in which case a
Transit Permit(VS Ne_621 i.w.....1.....1
• ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS R CREMATIONS ARE MADE
Date of. _ _ " 7 r9A4z
t or cremation
(Signed)......
(Person 014•
in charge) ._.__ aeAssooest.1121
(Name o£Cemetery,Cre atortu it,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 UNDER-
TASBIt MUST SIGN ABOVE STATEMENT,write across the face of the Permit
the words"No person in charge,"and BILE PERMIT WITHIN THREE(3)
DAYS with Registrar of District in which cemetery Is located.
EXTRACTS OF THE VITAL'STATISTICS LAW
373. 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 distract in which the death occtrred 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
peewit 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.
188 Duties of undertakers; interment within the state. If the inter`
meat or other disposition of the body is to be made within the state,the word-
ing.of the burial or removal persait 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 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.
; g81. Interments. No person in charge of any premises on which
interments or crematiens 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 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
registrar of the district"and file the burial or removalin which the cemetery ist llocatedn three
with days
Mr"SEXTONS and UNDERTAKERS violating the law relative to the re-
turn offArmits are liable to a penalty of NOT LESS THAN FIVE DOLLARS
spaRE THAN F}FTY DOf.Lw S FOR THE FIRST OFFENSE. The
teat all enforced. Local Registrars,are required,under penalty,to report