Garrett, Annette NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ts?This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra-
tion District(Town,Village,or City)in which the death occurred after the FILING and acceptance of a COR.
RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No 7•-._Z. + Registered-No..-._.—_- r ...
County--__—_- -- -_ Date of Death._._— 1. i9St
Town,Vil- s,..._ors Q -
lage,or City'-- — as+.6�tAge l Yrs. Color
(If city,give street dress) (�'Mos.)
Cause of Death. - e
ms.--1- y.__.
� _---- -- ,,- ---- - •----------•--
Place of Burial(or Removal)___t l! + 1_, _
Cemetery-__..�- ._. t��:-i1., ! _..1':_ ' Date of Burial 41; 3_i9.91
Certificate of Death of ___.-etn.a,.,•,4.)::Q ' q34.A..1%..L1T-----
(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/y stated Registered Number,and on the basis thereof I HEREBY G A PERMIT
g.../rr:, . yeZ 11..! i‘e
(Name of Ai to r)the__ --- �._-- .. - _.__z-t-._ _ ----------—to_..------_----- - --- ----. the body.
or�erson having charge of ) (Inter,remove,or of • of[state how])
Dated.-- _---_.__._____Ig_. (Signed)---__._. 'h &. Ct...___Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) a bed to part of shit
State (subject to local cemetery or other regulations),unless removal is by common oars r in Which case a
Transit Permit(VS No.62)is required.
ENDORSEMENT OF SEiTON OR PERSON' IN
CHARGE OF PREMISES ON WHICH INTER-
MENT OR CREMATIONS ARE MADE
Date of--AJJt"�-L: _ .�.—,.,,,..r
(� nt o 'cremation)
(Signed) ,_y
charge) . _ �
(Name of ery,Cre orium,etc.), ,
Person in charge must return this ermit to Registrar-of his District wit/du
SEVEN(7)DAYS from above date. no person is in charge,the'UNDER-
TAKER MUST SIGN ABOVE STATE NT,write across the face of the Permit
the words"No person in charge,"an BILE PERMIT WITHIN THREE(3)
DAYS with Registrar of District in w cemetery is located.
EXTRACTS OF THE VITAL STATISTICS:LAW
f 879. Duties of undertaker. each case the undertaker' or person
having charge of the corpse,shall file t certificate of death with the registrar
of the distnct in which the death o rred and obtain a burial or removal
permit prior to any disposition of the body. e • b The undertaker shall
deliver the burial permit to the person charge of the place of burial,before
interring or otherwise disposing of t body; or shall attach the removal
permit to the boa cone I'm g thecar when shipped by any transportation
company;said permit to a'hbmpany"'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. .
f 880. Duties of undertakers; in rment within the state. If the Inter.
went or other disposition of the body s to be made within the state,the word•
mg.of the burial or removal permit y be limited to a statement by the
registrar,and over his signature that satisfactory certificate of death,having
been fled with him,as required by la permission is granted to inter remove
or dispose otherwise of the body,stat'�g the name,age,sex,!cause,of death
and othernecessary details upon the prescribed by the tommmassioner of
•
f 881. Interments. No person' n charge of any premises on which,
in
ter or cremations are made eha or permit 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 shalt return all
permits so endorsed to the registrar of)his district within seven daysfrom the
date of interment or cremation. He shall keep a record of all boes interred
or otherwise disposed of on the premises under his charge,in each case stati g
the name of each deceased person,place of death,, date of burial'or dieposal,
and name and address of the uner( r• which ecord shall at all times be
open to official inspection; provided hat the undertaker or person having
charge of the corpse,when burying a body in a cemetery or burial
having no person in charge,;shall sigh the burial or removal permit giv
the date of burial,and shall write acro the face of the permit the words N.
person in charge,"and file the burial or removal permit within three days wi
the registrar the district in which the cemetery is located.
ler SEXTONS and UNDERTAKERS violating_the Taw tive to •
turn of permits are liable to a penalty,of NOT LES NE DO
NOR MORE THAN DOLLA�tS POE THE>o OPPENSE.
hue mill be enlarged. Local ReeinnRs,are required,ander penalty,to r•y0te
..t.A.at�--aL---..I