Colomb, Felix Form VS.CIL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
A. This Permit can be signed only by the Local Registrar (Deputy or aubregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERT WI' OF
DEATH, LEGIBLY WRITTEN IN DU LE BLACK INK. Town Ag Regi ed ... .../
Villag4117, / /12...& A
Dist. No./a/ Count 0 or City '
6 4 (If city,give street add 8)
Name of deceased • Veteran
*ngle, married, widowed, ckriadtizid ( f e ran, give as of War) e
Sex..Cleaareolor.. r divorced (write the word) . . Date of D . • die44,2(1::1)
Age •1?if Ye 7 Mon s Days so far !"rthplif e... . ..
Cause of eath. . _ ,
/ ..-
Certificate was s' .... ....
ra•• Alllireilliirir. M.D.
Address... .... .. • •a•te, joie
1,/,
Place of Burial (or yval .... ... .. . „„ ••• .....- ..," .. - -
(If body is to be tempor"7,,, Id r
01 ,e,/,0-
Cemetery .1;• •,,• •' i
Date of Burial. , .4 19:7./
(If body is to be t•m.orarily neld,fi „Si apace later)
Th4 Certificate of Death taming the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registrati n, ave recorded it in my Local e ord with the ahoy tated Re istered
Numb Ion the bath f I GRANT A PERMIT
0 )
the . to hold tempory,And .t body.
(U d er or person/rag cbargrorpse) v ,or e tem of[eta )
Dated'
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (ve‘ject to local
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ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of ... 1,Y7
(Signed) ,q�t t ( ferment
(Person
in charge)
(Flame of etery, Crematorium, etc.)
Person in charge must return this Permit to Registrar of his 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)
DAYS with Registrar of District in which cemetery is located.
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The body of any persor
whose death occurs in this state or which shall be found dead therein shall not bt
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
from or into any registration district,or be temporarily held pending further dispositior
more than seventy-two hours after death unless a permit for burial, removal, or other
disposition thereof shall have been properly issued by the registrar of vital statistics o1
the registration district in which the death occurred or the body was found. No such
burial or removal permit shall be issued by any registrar until, wherever practicable, a
complete and satisfactory certificate of death has been filed with him as heretofore pro-
vided; provided that when a dead body is transported from outside of the state into a
registration district in this state for burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
shall be given the same force and effect a. the burial permit herein provided for. No
registrar of vital statistics shall receiv a,'•y Ice for the issuance of burial or removal
permits under this act other than the coml,_nsation provided in this article.* Provided
however, that the commissioner of health shall have power to promulgate rules wit}
reference to the removal of bodies of persons whose deaths occur on trains, boats of
other carriers engaged in the transportation of persons within this state. (Am'd b}
L. 1932,ch.267.)
•See section 390.
§ 379. 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 it
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 chargo
of 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.
portation company; said permit to accompany the corpse to its destination, where ii
within the state of New York,it shall be delivered to the person in charge of the plact
of burial.
§ 381. Interments. No person in charge of any premises on which interments oa
cremations are made shall inter or permit t e interment or other disposition of any bodl
unless it is accompanied by a burial, crer;,ation or transit permit, as herein provided
Such person shall endorse upon the permit,the date of interment,or cremation over hi;
signature,and shall return all permits so endorsed to the registrar of his district withit
seven days from the date of interment or cremation. He shall keep a record of all bodie
interred or otherwise disposed of on the premises under his charge, in each case statinl
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 official inspec
tion;provided that the undertaker or person having charge of the corpse,when buryinl
a body in a cemetery or burial ground haling no person in charge, shall sign the buria
or removal permit, giving the date of burial, and shall write across the face of till
permit the words "No person in charge," and file the burial or removal permit withit
three days with the registrar of the district in which the cemetery is located.
re SEXTONS and UNDERTAKERS violating the law relative to the return o
permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORI
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced