Pruyn, Frederick Form VS No.61 F NEW ,.
STATE IS►EPAR1M N f OF H .T t
ALBANY •
OFFICIAL BURIAL (OR REMOVAL) PERMIT
rir This Permit can hi signed onlybt the Local Registrar(Deputyor Su6rp )of the Primary Registra-
tion District(Town,Village,or City) which the death occurred offer the FILING an of aCOR
RECl'AND.I��put E CERTIFICA OF DEATH.LEGIBLY WRITTEN IN DURABLE CIE INK.
Dist..No.. --.---• No—_....—........
County V. _ _ of Dea ■ -- =9_,
' :.. . Age `,r •
Town et Se . T �!__-Yirs. •Color... .-
Cmes Ant games not a cable) ,. I ` A
Cause of Death.- --- W- ��s.`e` ....
Place of Burial 0 a Ce e _
- - ,---- Date of B- •-!--I
'- A CERTIFICATE OF DEATH of........... ..__,...._. -••• -
(Give full name.of deceased)
-----
!laving been presented to me containing the above stated particulars,and,after caret examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED•B3
t :LAW,I have accepted the same for registration, have recorded it in my Local Reed T d With
t above
st Registered Nuntjs,and on the basis theeg�II„HEREBY GRANT A PERM'
tee . i7ndertekw, —- _ -_- ^(/l�' e) ' ' _.._
..-. -_--
the_-----_-_- __}; -- _ ------ •---------to. � •e4-"i.._. . , bo�dyt
(Und�e�r or_�_� having charge of*Wee) (Inter, ve.or other pe. '+J ,to howll'
• Dated__._ '`_mil. _..Iga i (Signied).... •^++[[ _ .._ ...._-..
Local R s 1
This Permit is sufficient for the Removal(and Interment or Cremation))of a boari to any part of the
state (subj9ect to local c.m.tenr or other regulation), proWded,that where removal is by eenemon carrier,
the above Permit muet be included in the Transit Perm.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENT OR CREMATIONS ARE MADE
Date of.. _. _ _.. _ ... _ _.. /7 ___ _._ryfi.
_ (In m taf cremation)
(Signed)
! ir,tic
(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 in In charge,the UNDER-
TAXER 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.
1 EXTRACTS PROM LAWS OF rex3,CHAPTER 6z,ARTICLE so.
{ F7g. 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. e * * The undertaker shall
deliver the burial permit,to the person in charge of the place of burial, before
interring or otherwise of the body; or shall attach the removal
permit to, bog cone corpse,"when shipped by any transportation
par k�_"i tat,_aseornnpsny the corpse.to its destination.where.i
within i e net
New"York,it sbailPle delivered to the person in charge
of the place of burial.
f MO. Duties of undertakers; intotruest within the state. If the inter-
matt or other disposition of the body it tobe made within the state,the word.
mg.of the burial or removal permit slay be limited to a statement by the
registrar,and over his signature that a.sati factory certificate of death,having
been filed with him,as required by larit permiseion is granted to inter,remove
or dispose otherwise of the body,stating the name,ag sex, cause of death
and other necessary details upon the form,prescribed by the commissioner of
1 Set. Interments. No person charge of any premises on which
interment'orcremations are made inter or permit the interment or other
i disposition:of Any body unless it Is . monied by a burial, cremation or
i transit permit,as herein provided: person shall endorse upon the permit,
the date of interment,-or cremation, his signature,and shall return all
permits so endorsed to the registrar of- district w seven days from the
date of interment or cremation. keep
re� bodies interred
or otherwise disposed of on the balder hie charge,in each case ta'
the name of each deceased p " "of h te'.of burial Or disp
and name and address of • which r 'shab at all times i e
' open to official on, 't the undertaker or person having
charge of the **pee,when a: y in a cemetery or burial gr
having no pens= in charge,shall aim he burial or removal permit
the date of all,,and shall write face of the permit the words,n
person in and file the val within three day
{' the registrar of the district in which cemeteryy�tocated.
tuna' SEXTONS re and»ffitT a 'HOT' ,w •, to re-
NOR •
MORE THAN FIFTY D i FOR ti 0 • Tee"
• hue will be enforced. Local ' 4 ' an required, +,to repeat
violations thereof.