Hoyt, Baby Boy -.mpg
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ini•This Permit ca be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra-
tion District(Town ViUairs.or City)in which the death seamed after the FILING and acceptance of a COR-
RECT AND COMPLETE eERTIPICATE OF DEATH,LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No. OPCI Registered No.
County. Warren Date of
Town, L(i1n&.Fa Y6ex-.- Age. _Yrs. Color )
lam or. t (Or M )
(li city,give street
Cause of Death..
Place of B 'imiZt Removal). . .
Cemetery
.—Date of B ' I' 9
.13 I
Certificate of Death of__
iname of deceased
having been presented to me containing th above stated p erg and, careful essumination,
the same •. • . to be COMPLETE, CORRECT, AN TISFACTOR AS REQUIRED
LAW, I <ye accepted the same for r then,have - •edit in my Btioordisith
the abov 'stated Registered um . .fx.„ HEREBYn
to. V4
- . rAdfirPW: ey
, -
the— .0% irAfrir ea 21.-1)",411r thehody.
) • of -D
Dated- 75e ( d,r,4tioriweno- vwze=4
or V' :411111. Local Reps
This Permit is sufficient for the Removal ( In tion of body to Dart of the
State (subject to local cemetery other regulations), removal is common acarriss.In Wilda'au*a
Transit Permit(VS No.62)is required.
ENDORSEMENT OF SEXTON OR PERSONS IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
•
Date of........._ _! •c! ..1 _ __....:g ,.
. (Interment or cr motion)
(Signed).. .._.. _
incharge
(Person llryta?...
(Name o metery,Cr6iatorium,etc.)„ •
Person in charge must return this Permit to Registrar of hie District within
SEVEN(7)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 in charge,"and FILE PERMIT WITHIN THREE(3)
PAYS with Registrar of District in which cemetery is located.
EXTRACTS OF THE VITAL STATISTICS LAW
having cchhargDuties
f the of
shall file In ccerttiificatte ose f d andertaker, or t with the registrare
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 Efface of burial, before
intern otherwise disposia of the body; or shall attach,t removal
} g �tiset
tl ' , said'permt to aBcc mppany co %qtsit» tiOn,,where if
within the state of New York,it ix de ere to tale person In.shapes
of the place of burial.
*MO. Duties of undertakers: intpem'+ent within ate Waist If.tine~Int
meat or other disposition of the body .to be mada within the state,the word-
ing o the burial or removal permit y;be limited a staff by the
registrar,and over his signature that aatisf certifida cif death,having
been filed with him,as required by law perm i'b,g to inter.remove
or dispose otherwise of-the body,Its the name:age,sea,cause Of death
a#..t other necessary details upon the m prescribed by the comotissioaer of
ll 88I. Interments. No :person charge of anyises op which
interments or•cremations are s inter or perm* in ent.or-other
disposition of any body ugp�iit is xnpanred by a 'I,cremation or
transit permit,as herein pr ii*Su person shell endorse upon the permit,
the date of interment,or cremation his signature,And shall all
permits so endorsed to the registratl of district within seven da s the
date of interment or cremation. I keep a record of alll interred
or otherwise disposed of on the prein under his charge,, case stating
the name of each deceased period, of death, date o�burial'Of dispos
and name and address of the, drt ; which record shah at all tins*be
open to official inspection;r• t:the undertaker or
charge of the corpse,when} y in a cemetery or
having,.no person in chaise,shall oien the burial or removal perm
to date of burial,and shall wane at the face of,the permit the words
in charge,"and file OW burial or removal permit within three ddaay$with
registrar of the district'in which the Cemetery is:located.
Ilt#"'SEXTONS and URDERTAXERS vio tin tile, relative to. `
n of permits ate liable to a penal of NOT $ FIVE D
on
OR MORE THAN FIFTY DOLL FOR TE FIROFFENSE. •TAs
wells he enforced. Local Regis ,are required, peditity,to
*dation.thereof. r'
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