Martin, Baby boy term .s.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tK 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 CERTI OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
a/�r�/ lXRed N.
Town . a
Dist. N County Village.. �.•o
Name of deceased ... /*`! or
U (If city, give street address)
of
e, l ed, widowey a
Sc � �� ..l�r,l,_��h���'v 1 0,-_ (write t�j /ord Date of •.��+� 1.. 9.
Age Ye; ,,,,!ls jet.,.. ay G Birthplac . . . . . . �.. ,..
Cause. of Death... ... ....
Certificate was sig.! D.
Address •
Place of Buria •r Removal - . ....... ,
Of body is to .far1lY held, fi ace later)/ .� Date of Buri ✓ 19. .
(If body is to be emporarily held, fill in 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 REQLIRED BY LAW,
I have acce ted the same for registry ion, have rec.rded it in my Local Re ord ith the a stated Registered
Number, on the 4is t.5reof Jr —e• I jam•' t;i' NT A PERMIT
r j */.
,1
the a►:/7�f to hold temporarily and. t
(Lnd or,':on h ig charge o�c!rp:e) er, rem ,or erwis ' ose of 1 to how])
Dated ,_ , 1' ;.. (Signed),
Signed)
.5✓6_ Local Regi ar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part o "the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62)-is required.
•
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
)ate of L. �.. r ` t� • L. 19..�,�t�
nterment ion)
;Signed).
(Person I
n charge
(Name of Cemetery, Crematorium,
Person in charge must return this Permit to gistrar of his District within
;EVEN (7) DAYS from above date. If no person is in charge, the UNDER-
CAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit
he words "No person in charge," and FILE PERMIT WITHIN THREE (3)
)AYS with Registrar of District in which cemetery is locaj,ud.
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The body of any person
:hose death occurs in this state or which shall be found dead therein shall not be
nterred, deposited in a vault or tomb, cremated or,otherwise disposed of or removed
roin or into any registration district,or be temporarily held pending further disposition
nore than seventy-two hours after death unless a permit for burial, removal, or other
lisposition thereof shall have been properly issued by the registrar of vital statistics of
he registration district in which the death occurred or the body was found. No such
Curial or removal permit shall be issued by any registrar until, wherever practicable, a
:omplete and satisfactory certificate of.death has been filed with him as heretofore pro-
ided; provided that when a dead body is transported from outside of the state into a
•egistration district in this state for burial, the transit or removal permit issued ip
accordance with the law and health regulations of the place where'the death occurred
,hall be given the same force and effect as the burial permit herein provided for. No
'egistrar of vital statistics shall receive any fee for the issuance of Lnrial or removal
permits under this act other than the compensation prvideo.1 in this article.* Provided,
towever, that the commissioner of health shall have power to promulgate rules with
•eference to the removal of bodies of persons whose deaths occur on trains, boats or
ether carriers engaged in the transportation of persons within this state. (Am'd by
1932,ch.267.)
•See section 390.
§ 379. Duties of undertaker. In each case the undertaker, or person having
:harge of the corpse,shall file the certificate of death with the registrar of the district in
vhich the death occurred and obtain a burial or removal permit prior to any disposition
>f the body.***The undertaker shall deliver the burial permit to the person in charge
if 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-
iortation company; said permit to accompany the corpse to its destination, where if
vithin the state of New York, it shall be delivered to the person in charge of the place
if burial.
§ 381. Interments. No person in charge of any premises on which intermEnts or
:remations are made shall inter or permit the interment or other disposition of any body
mless it is accompanied by a burial, cremation or transit permit, as herein provided.
inch person shall endorse upon the permit,the date of interment, or cremation over his
ignature,and shall return all permits so endorsed to the registrar of his district within
,even days from the date of interment or cremation. He shall keep a record of all bodies
nterred or otherwise disposed of on the premises under his charge, in each case stating
he name of each deceased person, place of death,date of burial or disposal,and name
Ind address of the undertaker;which record shall at all times be open to official inspec-
ion;provided that the->,tndertaker or person having charge of the corpse, when burying
body in a cemetery or burial ground having no person in charge, shall sign the burial
pr 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
hree days with the registrar of the district in which the cemetery is located.
SEXTONS and UNDERTAKERS violating the law relative to the return of
,ermits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
CHAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.
.nenl Reoistrari_ Are renuired. under nenelty_ to rennrt vinlatinne ther..,,f