Hughes, Baby girl Form VS.81. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tgr Thu Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFIC4TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No. 3 1 O
Dist. No..SI'(2! County w ., o`r C tye .)-}44^4 .)61 A
Q, p / (If city, give street )
Name of deceased P /��^'� .l4j% Veteran
Single, marr ed, widowed, .. (If veteran, give name of War)
Sex..7:44+14..Color... ...or divorced (write th//e//wor (4`^1•'4 Date of D th ad7 " 19...S.f.2
Age Yew Mon s 7 .,2,r Birthplace..: ..T.. 4g..,...7J.:.,.
•
Cause of Death .171-4 •dwaG sd V 2--
Certificate was signed by.,-/- , M.D.
Address Li 5,:.3 'evi .. 7_ ,,4141 ..... .4
Place of Burial (or Removal) W.. .. .7a1,0- f
(If body Ia to be ternpo artly,��hl Id,fl !a ayy��ppee later)
Cemetery...L.(/ /d ^�. �Ki �Y4�fw� Date of Burial , 4 19 V 2
(If body is to be temporarily held,fill In space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Num on the sis they f'I HEREBY GRANT A PERMIT /J Qi 44.4 ?%
to. p ame) /G�(.titi i2(iil ddress)
the /�.... ............to hold tempmaril �ifd.... .. . •--1-A e body.
nd��rta er orrsoa having charge of orpse) m o rw ion o
Dated Gl fs!- 19.4.1/ (Signed)
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subjee to ocal
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
. ,
Date of. ... . . .. ....)
(fwerm-j,v... atiy,n) —
(Signed) 10 ' 1- -6.(e).../e .,. i , ...
(Person
in charge) . 24/-4421f h '7(.aart6 f , , I .. . .
(Name of Cemetery. Crematorium, etc.) -
Person in charge must return 'his Permit to Registrar of his 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 heated.
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The body of any person
se death occurs in this state or 4iicT. shall be found dead therein shall ri,,t be
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
from or into any registration dist.d.,,or be temporarily held pending further disposition
more than seventy-two hours aft-rdeath unless a permit for burial, removal, or other
1., disposition thereof shall have been properly issued by the registrar of vital statistics of
the registration district in which the death occurred Or the body was found. No such
'burial or removal permit all be issued by any registrar until, wherever practicable, a
complete and satisfactory rtificate of death has been filed with him as heretofore pro-
vided; provided that wheel a dead body is transported from outside of the state into a
registration district in this state for burial, the transit or removal permit issued in
accordance with the law ad health regulations of the place where the death occurred
shall be given the same force and effect as the burial permit herein provided for. No
registrar of vital statistics shall receive any fee for the issuance of burial or removal
permits under this act other than the compensation provided in this article.* Provided,
however, that the commissioner of health shall have power to promulgate rules with
reference to the removal of bodies of persons whose deaths occur on trains, boats or
other carriers engaged in the transportation of persons within this state. (Am'd by
L. 1932,ch.267.)
•See section 390.
§ 379. Duties of uAdertaker. 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 peimit 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 trans-
.. , .,.
trans-
; said permit to , - _pse to its destination, where 11-
" l
W In ' a rehrN"-ew York, it shact, 7-4trepers,as'i in charge-of the:loadaee.,-
of burial.
§ 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 arty 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 inspec-
tion;provided that the undertaker or person having charge of the corpse,when burying
a body in a cemetery or burial ground hiving 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.
tr 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.
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTI I946. OF
DEATH, LEGIBLY WRITTEN 1N RABLE BLACK INK. R ' ere o.... Q(
/ Town
Dist. No664/...County .Vill a ., .., . ...
/f / iria
o (If city,give street ddress)
Name of deceased .'b��. ..
n• :married, widowed, / a /
S olor..� : vorced (write the w. r.. ' Date o e ... 9... . . ..j-CA.LziAge Yonth�../... . t.,! 3J thglace... 7.. .. i
Cause of Death.. .. �G!! - . _ -I .
C%�Certificate.was sig ed la.... . . r .. ,./. / .!/�,., .D.
Address...`.. s...,, •���? .. _ !//.... ... e' , o..�y /�� *,s •
Place of Burial (o Re o . /.e /% . .. . �.T lJ/J•
(If body is to be t:,.,,,, aril )01.pace late. / J
Cemetery... . ../' .%...►,��%. .... .. 'jI Date of Buri ael �... 19 //
(If body is t. .e • •porarily h•Id,fill in space la er)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, t•e same appearingto be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have� e. • the same r r gistr ion, hay- record it ' my cal Record with the abov tated Registered
1;"
P.1.
the . .- eof I ER GRAN BM
the ii,//%/�0/ . ..e) (
� to hold tempora '1 d e body.
(U o�Z :on�llsa4ing charg c pae)itOr , e v he se d e of s o )
FFIXIX 1
Dated 19.. .... (Signed).
..
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ubject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) ' required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
. Date of QL°r • O 19.. ..7..
(Inte nt or crema n)
(Signed)
Person
i charge) � a t a/46 ...!✓�j :�Y
(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 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
§ 375. Permits for burial or removal of dead bodies. The body of any person
whose death occurs in this state or which shall be found dead therein shall not be
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
from or into any registration district,or be temporarily held pending further disposition
more than seventy-two hours after death unless a permit for burial, removal, or other
disposition thereof shall have been properly issued by the registrar of vital statistics of
the registration district in which the death occurred or the body was found. No such
burial or removal permit shall be issued by any registrar until, wherever practicable, a
complete and satisfactory certificate of death has been filed with him as heretofore pro-
vided; provided that when a dead body is transported from outside of the state into a
registration district in this state for burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
shall be given the same force anti effect as the burial permit herein provided for. No
registrar of vital statistics shall receive any fee for the issuance of burial or removal
permits under this act other than the compensation provided in this article.* Provided,
however, that the commissioner of health shall have power to promulgate rules with
reference to the removal of bodies of persons whose deaths occur on trains, boats or
other carriers engaged in the transportation of persons within this state. (Am'd by
L. 1932, ch.267.)
•See section 390.
§ 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 trans-
portation 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.
§ 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 inspec-
tion;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.
thr 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.
Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (To
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIF F
DEATH, LEGIBLY WRITTEN IN RABLE BLACK INK. Registere o... ..
Town �.
Dist. N ..County Villa
/,� / 0 or (If city,give street aildres
Name of deceased.... 45�";r►� .
'ny'-, married, widowed, ci
S olor..... Cd. ...ivorced (write the Date .f li h.. J.... 7.� .19.7./.
Age Yea Months... . .... Birt ce'�``' ... .. O� ';
Cause of Death
Certificate was signed�.y • !vl M.D.
Address �`' ... 7.
...
Place of Buria ' .r • -m )
(If body is to , ...ore... , n space la er) J �/f ,
Cemetery., / Date of Burial .. . r.L�f�+. 19..1./
(If body is to be temporarily held,till in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I ha-e accepted the same for registration, have recorded ` in my Local Reco . • h the abo stated
Registered
Nu f,er/ on th tieof ERE ANT r ` :. j, / %�
(Aar
the to hold temporaril body.
( eraring charorpse) ov r o e i is,) [state h
Dated.... 1 (Signed)..., . .
Local Registrar
This 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 SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
b
Date of °fit. a 19...T..
(Intern�w�or crew 'on) /
(Signed) /e�( l�it��...t ,� 2/�I ..t
(Person
incharge) . , ...... 11Y. (..e L x ff!.
(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 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
§ 375. Permits for burial or removal of dead bodies. The body of any person
whose death occurs in this state or which shall be found dead therein shall not be
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
from or into any registration district,or be temporarily held pending further disposition
more than seventy-two hours after death unless a permit for burial, removal, or other
disposition thereof shall have been properly issued by the registrar of vital statistics of
the registration district in which the death occurred or the body was found. No such
burial or removal permit shall be issued by any registrar until, wherever practicable, a
complete and satisfactory certificate of death has been filed with him as heretofore pro-
vided; provided that when a dead body is transported from outside of the state into a
registration district in this state for burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
shall be given the same force and effect as the burial permit herein provided for. No
registrar of vital statistics shall receive any fee for the issuance of burial or removal
permits under this act other than the compensation provided in this article.* Provided,
however, that the commissioner of health shall have power to promulgate rules with
reference to the removal of bodies of persons whose deaths occur on trains, boats or
other carriers engaged in the transportation of persons within this state. (Am'd by
L. 1932,ch.267.)
•See section 390.
§ 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 trans-
portation 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.
§ 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 inspec-
tion; 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.
re 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.