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Goldman, Jacob r acm•o,1,•V a. ..-. v vvv ..-......... NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT • s9►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�'p CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist No 15-Gdl R .egi .-... County ... ---- Date of Dea ------_--_-._-.- I Town,Vil- ft. . ••Sep . Ages Yrs. Colo ._...._.._. ..� lag ,er City.' - _ _ __.... _ - (If city.give street address) os.) Cause of Death_... ._ ._._ _ _ .__ _._..._ _+ ----- . _ I Place of Burial( emoval). 4e ----, =-.-- _Lemetery. ---- _._ _ _ _ = Date-of Bui _.—._.___._ ..19 , Certificate of Death of ----- __ --__._-_-.- ,____ -- (Give full tame of deceased) having been presented me containing the above stated particulars and, after careful examination the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I ye accepted 4,- same for registration,have recorded it in my Local Record with the abov fated Regis N her,and on the basis re I HEREB GCS A lovr :./`_.. (Name•� ;f: � �_.._.. to.. - (Address)._ ... _ % ..`r r"lS.' •r :charge se) -(In ve,-or of t':r Z:'4, c7prp — — . jrae DAte(1_-�:7' � �"_ 19�.Li (Signed�, -.'dam Local Regis This Permit is sufficient for the Removal (and Interment or Cremation) of abedy to any girt of thu State (subject to local cemetery or other regulations),unless removal le by common carrier,in which case a jig Transit Permit(VS No.62)is reouired. • ENDORSEMENT 0: s .6✓ OR PERSON,. IN CHARGE ©F PRE, 1 . ` tN NCH INTER- , MENTS'0 C = ONS AIM MADE Date Of _ .. `' ..•,ahem),.. ^ la ehuge) t t'f'• " ... (Name Cremate a,stc.) Person In charge must �C O. emit to Stemmer of his District within 'EFEN(7)DAYS from abort i. ' no person is hi"charge tie UNDER- TAX:ER MUST SIGN ABOVE A ' a across-the face Permit�!.the the words"No person in .,. a" '`'. PERMIT wrnail THREE(3) DAYS with Registrar of District ' eemeter7 is Iocatsd, EXTRAC TS OF "1: � STATISTICS LAW s nit Dud.'limes of ot: f sass► �*r' or of the having dal in whichh •�` I and,bd bw�alor permit prior to any dispoa; undertaker deliver the burial permit to a . arms of the of burial,before interring or otherwise des y; or attach the removal anlyi'�p ^i� within the state of New York, • it be delivered to the person in charge of the place of buried. gs0. Duties of and ; 4 terment within the state. If the inter* meat or other disposition of the body is to be made within the state,the word- ing'of the burial or removal t may„ be limited to a statement by the registrar,and over his signature t d satisfactory certificate of death,having been flied with him,as required law,permission is granted to intertremore or dispose otherwise of the body stating the name,age,sex,cause of•death and other necessary details upon 'form prescribed by the commissioner at health. r • 381. Interments. No.. +in charge of any premises on which interments or cremations tie shall inter or perm•it the interment or other disposition of any body unless i is accompanied by a burial,cremation or transit permit,as herein provided ch person shall endorse upon the permit. the date of interment,or on ver his signature,and shall return all permits so endorsed to the his district within seven days from the date of interment or cremation. a keep a record of all bodies interred or otherwise disposed of on the under his charge,in each case stating the name of each deceased p1 ea of death, date of burial or dispo: and name and address of e u ert ; which record shall at all times be open to official inspection; providedt the undertaker or person having charge of the corpse,when b' body in a cemetery or burial ground having no person in charge, • the burial or removal permit giving the date of burial,and shall write , the face of the permit the worts "No person in and file the • removal permit within three days with the registrar of the district in ch the cemetery is located. m"SEXTONS and viela he law relative to the re• tors of are liable' a. 1 f NOT THAN FIER DOLLARS NOR MORE THAN PUTT FOR FIRST OFFENSE The lam will be enforced Local is .are required.under penalty,to tepee A .rnletl..s thereat-