Paouty, Harry Form VS NO.61. 8-s-7n-muss nil-Dave)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
aa-T his Permit can be signed only by the Local Registrar(De uty or Su}regiatrar)of the.Primary Registra.
tion District(Town Village or City)in which the death occurre after the FILING and acceptance of a colt.RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No..__5.091............
,�J _? Ig3r
County._�� a t . __. . __ _ Date of Death._._ k
Town, lens Fdsis. se Age.I Yrs. Color--_. _.. .r
r C �hl- ' w... .._._ _� (Or Mos.) .
(If city,give street ..
Cause of Death.... '/ . t .* # A.- Al ..'....
Place of Burial emoval)---• . 1_ , ..�
Cemetery -=--. . - _ _-4?-------------.---------------
having .__ _ Date of BuriaL.�Q�(1--1_.I.+._..Ig ..!
Certificate of Death ofheL4 —been presented to me containing a above stated particulars and after careful examination,
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, have accepted • same for registration,have recorded it in m Local Rec d with
the . .' stated ` ,and on the basis I A PERMIT
41„
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 renwoal is by common carrier,in which case a
T.....It 11w.....1*Mt 1.U._-1.^r1 is......1...1
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER
MENTS OR CREMATIONS ARE MADE
Date of e. /4, efuglie
In urns �asemation)a�rs y
chap)in 41 . .. . .�...� .. .
(Name of Cemetery,C toriwn,etc.).
Person In charge must return this Permit to Registoalef his District within
SEVEN(7)DAYS from ahoee date. It ao person is la charge.the 1711DER-.
TAXER MOST SIGN ABOVS'STATEMENT,write across the face of the Permit
the words a No person in'charge,"end FILE PERMIT wziw&s THREE(3)
DAYS with Registrar of District is which cemetery is located.
EXTRACTS OF THE VITAL STATISTICS LAW
f $79. Duties of undertaker. In each case the audertaker' er Dentin
haviog charge of the corpse,shall file the certificate of death with tie registrar
of the district in which the death occurred and obtain a burial os removal
;permit prior to any disposition of the bog}'. • • O The undertaker shall
deliver the burial pit to person in c .+ge of the place of burial,before
b or otherwise of the body; or shall attach the removal
Permit to the boa containing' corpse,when shipped by any transportation
coampany; said permit to sny the corpse to its destination.where if
within the state of New York,it shall be delivered to the person In charge
of the place of burial.
+3110. Duties of undertakers; interment within the state. If the
meat or other disposition of the body is to be made within the state.the
weed-
ing of the burial or removal permit may be limited to a statement ley the
registrar,and over bis signature that a satisfactory certificate of death,having
been lied with him.as required by law,permission is granted to later remaye
or dispose otherwise of the body,stating the name age,sex,cause or death
�toother necessary details upon the form prescribed by the commissioner of
•
}f81. interments. No person:In charge of any premises on which
interments or cremations are made shall inter or the interment or other
disposition of any body unless it is accompanied by a burial,cremation or
transit permit,as herein provided. Such person shall endorse upon the permit
the date of interment,or cremation over his signature,and shall'Warn a$
permits so endorsed to the registrar of his district within seven days from the
date of interment or cremation. Ile shall keep a record of all bodies interred
for otherwiseri disposed of on the premises under his charge,in each case stay"
each deceased person place of death, of burial or
and name and address of the undertaker; which recordshall at all tunes be
open to official inspection; that the undertaker or haying
charge of the corpse,whe bury a body in a cemetery or burial gr
having no person inshall sign the or removal permit giving
the date of burial and charge,rite across the face the permit the words "No
person in i'and file the burial or removal permit within three days with
the registrareg the district in which the cemetery is located.
8BITONS and UNDERTAKERS vieleithuLthe
to
a$• > "i e l BIeTYto DopenalT SoNOOT
8 IRW OFFENSE. S
The
as edit A.enrereed. Local Registrars,are required,under penalty,to rsleit