Kenwell, Carrie NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL)PERMIT
asrThis Permit can be signed r(ly by the Local Registrar(D uty a Subre iatrar)of the PrinnaryRegistra-
tion District Town Village,or City)in which the death after the FILING and roceptense of a COR-
RECT'AND MP CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE DI.11Clf.INK.
Dist No Regi ed No...
County. a .__ D e of Death �',.�dr__ a__
_ ic*
Town,VA, Se
Iage,,or City 'a t - QG e s. Color
11F :
(If city,give street address) -
(Orr .)
s)
Cause of Death
Place of Bitcial,(or Removal) PM"Q-iL.tili4_
Cemetery'- Date of.B ' 1.1 .?_ _ig
C*rti cateof Death of. ---•-- _.:_ _' _ _ �. _._. __.
(Give full name of deceased)
having been presented to me cohtaining the above stated particulars, and after careful examination,
the sane appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY
LAW, I bar+ a -a• ed the same for registration,have recorded it in my Local Record with
the red ber,and on the basis th I FEY GRANT A PERMIT
to. _�►
(Hama
the --•- _..� _ fit._ — —-to. ,IP body..
,(flndertaker or person haviug charge of corpse) ( ove,or_othirprilispostof lat to howl).
Dated__--fi-rZ2...a.°.VIC (Signed)..
Local Registrar
This Permit is sufficient for the Removal (and Interment em'C ma on) of a body to any part of the
State (subject to local cemetery or other regulations),unless removal is by common carrier,in which cease
Transit Permit(VS No.62)is"evoked.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MINTS RRCREMATIONSS MADE
Date of....---....—
.dn� oa _ _.,. _..
(lipped)-- Le!yMe _ _
is oharga).�►' ame�f'�+wt or,etc) "tq`'
torfnm,etc.)
Person in charge must return this Permit to Registrar of his District within
SEVEN(y)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 is charge,"and FILE PERMIT WITHIN THREE(a)
DAYS with Registrar of District in which cemetery is located.
EXTRACTS OF THE VITAL STATISTICS LAW
§ Mil. 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
ed Lori the burial permit to the person in charge of the place of burial, before
or o ise of the boy: or shall attach the remtov
• permit to accompany corpse its104 ht .$
WO,
state of New York,it shall be delivered to the person innc charge
the place of burial.
f 880. 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 word-
ing.of the burial or removal permit may be Hurtled to a statement by the
registrar,and over his signature that a satisfactory certificate of death,having
been filed with him,as required by law,percussion is granted to inter.remove
or dispose otherwise of the body,stating the name,age eat,cause of death
and other health necessary details upon the form prescribed by the o�of
881. Interments. No person in charge of any premises onwhich
interments or cremations are made shall inter or permit the interment ot 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 shalt return all
permits so endorsed to the registrar of his district within se *TS from the
date of interment or cremation. He shall keep a record of an boam interred
or otherwise disposed of on the premises under his charge,in each case sta
the name of each deceased person, place of death, date burial,or and
and name and address of the undertaker; which record at all times
open to official inspection; provided that the undertaker of person illuirot
charge of the corpse, when burying a body in a cemetery Or burial
having no in charge,shall sign the burial or removal giving
the date of iall;gud shall write the face of the permit the wads,"No
person ist11acge, 1$file the burial or removal permit within,three days with
the reDttrar the district in which the cemetery is located.
SEITONS and UNDEATAXERS viola' the law to�th�e,Vie-
are liable to a V of NOT LH8� I1E.The
NOR RE TRAIT FIFTY DOLLARSFOR 81i. The
lass sell is enforced. Local Registrars,are required,under penalty,to resat
.ini.H.m.ih.r.ef_