Mulford, Teressa Form VS No.61 NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
OFFICIAL BURIAL (OR REMOVAL) PERMIT
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 aJ the FILING and acceptance of a CORRECT AND
COMPLETE C ICA OF DEATH,LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No.2� Registered No.
County Saratoga _ Date of Death Mare 24th 19 31
Town, Vil-
lage, or City_....SO a Gle ns r_aLl$ _ Sex........f• Age.48 Yrs. Co1or_whi.te
(If city give street addres , (Or Mos.)
Cause of Death. splice ilia-carcemon a of liver & breast_ ._...__
Place of Buria Ceme
(or Removal) lne_..vj-L' _ tery GleTls Fal. , e of Buria1.3/2_..6._._19 31
A CERTIFICATE OF DEATH of Terre. _,Tf?rPgga. An. M l f(Ird
(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 C. ...Stafford N. Y.
'lens Falls, N. Ye __,
(Name of Undertaker) (Address)
the _._._...___._.....un.cl.5'r. k�'i ._._ _ _ _to_..__ lilt s.,r....._...._.__ _the bod .
(Unde t ker or,perx) in charge of cor Inter, remov r otherwise di to how
._19_._.9A (Signed)- - --,.-
Local Regi ar
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.
ssso
1t}2O47-7s,OD0(1744Da)
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE Date of �'
( tgrm� _.�.-!t"- � 18�... ... r cremation}
(Signed)Person
/�
in charge)/t e-'�`,i-eed
(Name of Cemetery, . ematorium, etc.) ,�
Person in oharge must return this Permit to Registrar of his. District
within SEVEN (7) DAYS tram above date. If no person la in charge, the
UNDERTAKER 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 oemetery is located.
SECTIONS OF THE VITAL STATISTICS LAW.
f 870. Duties of undertake*. In each case the undertaker, or person
having charge of the corpse, shall file 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 piece of burial,
before interring or otherwise disposing of the body; or shall attach the re-
moval 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.
§380. Duties of undertakers; interment within the state. If the inter-
ment, or other disposition of the body is to be made within the state, the
wording of the burial or removal permit may be limited to a statement by
the registrar, and over his signature, that a satisfactory certificate of death,
having been filed with bimo as required by law, permissioa'is granted to
inter, remove or dispose otherwise of the body, stating the name, age, sex,
ranee of death, and other necessary details upon the form prescribed by the
commissioner of health.
S 381, Interments. No person in charge of any premises on which Inter-
ments 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. Stich person shall endorse upon the
permit, the date of interment er crematqlon over his signature, and shalt.
return all permits so endorsed to the registrar of hie district within 'even
days from the date of interment or cremation, He shall keep a record of all
ladies 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 ofcial Inspection; provided that the undertaker
or person having charge of the corpse, when burying a body in a cemetery or
burial ground hawing 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.
Er 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 wilt
be enforced. Local Registrars,are required,under penalty,to report violations
thereof.