Titus, Haviland — - - -- -- NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
AFi"This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra.
taw District(Town V lege,or City)in which the death occurred after the FILING and tame of a COW. •:
- RECT AND CO P�j ERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLEBLACK INK.
Dist Not - , Register
Countigsrar. ___ __ Date of Death___ __• _2,
�
Town sex_QH e-•�--7 Yrs. Color
.age,or Ci (or-lgos.)
(If city,give tad
Cause of Death.--- -- - -
Place of Burial(or Removal) ....... _...._.....---
Cemetery.,
y _ __l1C _ _ -f ___- ..-Da of ural - -Z� f Certificate of Death of�� _ _ -•- --------•---- - _ _._�.._...
(Give full me of )
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 •stration,ha ecorded it in nay Local Record with
the ve stated Regis the I HEREB A PERM
) ( )
the.. ___ ____. -- _the body.
u talwr or sea k charge °) (In , ,or Re state how])
Dat - --_ ` (signed) -
iocat Regstrar
Th Permit is sulfide for the Removal (and Interment or Cremation) of a body to any part of the
State (subject to local ceme or other regulation.),unless removal is by common carrier,in which case a
Transit Permit(VS No.62)le required.
.
'ENDORSEMENT OF, SEXTON OR PEtSON IN
CHARGE OF PREMISIS ON WHICH INTER-
MENT/S OR CREMATIONS ARE.MADE
Date of. l..- .. ...�..f 1--( ...4.. .....39+c 2'
1Ined
chaste) ... _-..._.... , _. "� "ie __ .._. - _
(Name at M etery.Crematorium,etc.)
Person In charge mays!return Permit to Registrar of his District within
SEVEN(7)DAYS fronkabove , II 00 Person is in charge,the UNDER-
YAW MUST SIGN ABOVEST_T NT,write across the face of the Permit
the Words"No person in charge" d FILE PERMIT�THREE(a)
DAYS with Registrar of Distrct la which cemetery is located.
-.*EXTRACTS OF T D VITAL STATISTICS LAW
¢$7a Duties of ,' Le each case the undertaker, or person
hacker charge of the corpse,shell ,' the certificate of death with the registrar
et the district in which the des ,,occurred and obtains burial or removal
rgprior to any tkm the body. * * + The, ndertaket
the burial per • .. charge of the- of burial,before
interring or otherwise , the body; or shaft"attach the removal
permit t0 bolt . when peed.b
'wttl to York,it' '.� I Abe�to person c
of the place of burial.
t$g0. Duties of undertakers; interment within the state. If;ass inter-
ment other disposition of the body is to be made within the state.the word-
ingo� the burial or removal permit may be limited to a statement by the
registrar,and over his signature that a satisfactory certificate of death,having
beed Meth With him,as by law,permission is granted to inter
orp Otherwise of the y,stating the name,age,sex,cause:or death
necessary details upon the form prescribed by the commissioner of
A I Inteniterds. No person in charge of any premises on which
or cremations are made hall inter or permit the interment or other
of any body unless it is accompanied by a burial, cremation or
transit permit,as herein provided. Mich person shall endorse upon the permit,
the date of interment,or cremation over his signature,and shall return all
permits so endorsed to the registrar of his district within*even days-from the
date of interment or cremation. lie shall keep a record el all bodies interred
or otherwise of on the premises under his charge,in.each case sta'
the name of deceased person, place of death, date of burial or disga
end name of the under)aker; which record*hall at all time.
open to pection provided that the undertaker or person ba
charge of the Coe,when burying a body in a cemetery or burial
having in charge,shall sign the burial or removal permit g
the date •. i�id shall write across the face of the permit the words, No
''person gild file the burial or removal permit within three days with
the registrar district in which the cemetery is located.
"EV"BEZTONS and UNDERTAKERS violating the law relative to tit.re-
turn of is are liable to 4 FEW NOT L DO1
willNOR NOIR law forced. Local *glitters,are required,F �,to repot