Scales, George Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Or This permit can be signed only by the Local Registrar(Deputy or Subregistrar) of the Primary Registration
District(Town.Ne e,or City)in which the death occurred afterthe FILING and acceptance of a CORRECT AND
COMPLETE TE F DEATH,LEGIBLY WRITTEN DURABLE BLACK INK.
Dist No.__ C ..ir Registered No.
County Sarat qg8„._„.:.. „...M Date of Death. r!6th ..._19 31.
Town, Vil 4.
-
lage, or City g...��. ens.. '$ e$ ._... Sex._. a _ Age -Yrs. Color.....
(If city give street address) (Or Mos.)
Cause of Death__cerebral Iemmorhag('t.._.__..._._.._._... ._._..._......_..___._.._ __
Place of Burial Cem --1 e �
(oy Removal)_.P1Y1_G'_v !.„„ -_ _ tery Bens Falla.,diate of Burial...` ,L 9_....... 19
A CERTIFICATE OF DEATH of George H. Scales
(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 accepted the same for registration, have recorded it in my Local Record with
the above stated Registered Number, and on the basis thereof I HEREBY GRANT A PERMIT
to.. Harold__.,G.� Stafford 109 Maple St,Glens Fes?ls
the u fN3'meeri U_q_debra. er) inter (Address) �W W„„µ
....,..„..„...._._.„U....„_._...T.,..c.'t,...K......__..r......._.._......„._W._._._._... to..._................_._....._... .W the o
eif
(Undertaker or person having charge of cor ) (Inter, remov i otherwis is [state
Dated . ...i.1. �1 _ _.__.._.---__19� (Signed)- -...._.... . _1/.1._.
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 62) is required.
mannataw
164047-75.000(17.201)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date of 6 poe-- 19.3-7
or t or cremation)
(Signed)
(Person
in eharge)graci..., aea,eee
(Name of Cemetery, Cr tortoni, etc.)
Pollen 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
UNDERTAKER MUST SIGN ABOVE STATEKENT, 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.
SECTIONS OF THE VITAL STATISTICS LAW.
a no. Duties of undertaker. In each ease the undertaker, or person
having charge of the corpse, shall die the certificate of death with the reg-
istrar 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 Mottling of the body; or shall easel, the re-
moval permit to the box eontaluing the,corpse, Iv stil by any tram!-
.
,,jIn o the plackw of 4
, -
• us. Ditties of ; entailment',Mitt the state.
Mont, or other dispotlon of'the Medy is to be.,inade within the stitteo,
'wording of the burial or removal 'permit may be limited to a statement
the registrar,.end over his signature, that a satisfactory certificate of death,
having beets filed with him, as required by law, permission le granted to
inter, remove or dispose otherwise of the body, stating the name, age, eel.
Cause of-deitb, and other necessary details upon the form prescribed by the
commissioner of health.
§ast. Interments. No person in charge of any premises on which inter-
ments or cremations are made shall inter or permit the interment or other
(Deposition of any body unless it is accompanied by a burial, cremation or
transit permit as herein provided._Ouch person shall endortie-alltesww0ite'u.'
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
clays from the date of interment or cremation, lie shall keep a reseed of all
bodies interred or otherwise disposed of on the premises ander his chargh In
each case stating the game of each deceased person, place of death, deb; of
burial or disposal, and name and iiddress of the undertaker; which 'record
shall at all tibiee be open to official inspection; provided that the undertaker
person having charge of the corpse, when baryintc_it,hagy In a cermet-erg Or
binial ground Ittretffir on person In charge, shall sign the burial or removal •r,
permit, giving the date of burial, and 'Mall write acmes the face of the
permit the words "No person in charge." and file the burial or removal
permit within three day e with the registrar of the district in which the
cemetery is located.
lar'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 reform,. Local Registrars,are required,under penalty,to report violation,
thereof'.