Duell, James farm A S.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t2r 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 CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No.
Tow•n
Dist. No s'`S County �) Vi+lage...
O V (If city, give tree}address)
Name of deceased4 a• ,����
i
ied,
r1diieorcedr(writeltthe word) ,
Sex. l.4. Color Date of Death� a1 1i •
19. .7
Age $./ Years `7 klonths Days. Birth Inc. . :(.G ��? of
Ca.use.ofCertificate was Death.sign signed by Q . ' .!S r.: .r... . . .. ... . :.. 1JG�� fist- —it J I.D.
Address - 7 / - ' �%4' 'y � 6Yi
Place of Burial (or Removal): Lf . - ./ `-72 ..
(If body is to be temporarily held, nil in space later) ,_
Cemetery.....frL-V 1 .... . ... Date of Burial ~""1"1"1 '' / 3/ 19. i<
(if body is to be temporarily hel , liP i space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT. AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number and on basis they f I l; BY GRANT A PERMI
1 dc, tu o—r-s.....4-1....-. r /- ,I7,-,,
Na c/V, � : ,,,K.,,A.re,$) ,,
the to hold temporarily an .-. t...:- ,„, the body.
(Undertaker or on having charge of corpse) . .ove,or otheru'se dispose of [state how])
Dated: ,! 19.. (Signed)... .... ... / ..� .rwr._
►�i ir Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation . a bo• , to any part of the State (subject to local
cemetery or other regulations),unless removal is by common carrier, in whit. case/a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON JN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 71100....(1..19
f.ntermettretryupartAerernatiot)
(Signed)
(Person WaAet-A imetA 7,00165 94‘,44,
in charge)
(Name of Cemetery, (rematorium, 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 he found dead therein shall not be
interred, deposited in a vault or tomb, cremated or onerwise disposed ul 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 tiled with him as heretofore pro-
vided; provided that when a dead body is transported Iroin 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 he given the same force and effect as the burial permit herein provided for. No
registrar of vital statistics shall receive ay fe for the issuanee—i-f burial-or removal
Permits under this act other than the copttisation pr‘Jvidod in this .irticle.* Provided,
however, that the commissioner of healtl shall have power to promulgate rules with
reference to the removal of bodies of pei'otis 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 Bach 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 keen 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 he 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 clays with the registrar of the district in which the cemetery is located.
IV 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 oenaltv. to report violations