Branch, Charles NEW YORIC STATE DEPARTMENT OF HEALTH
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OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra-
tion District(TyaiVill ,or City)in*blob the death occurred alter the PILING and acceptance of a CO
RECT.AND CO rE CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN'DURABLE BLACK INK..
Dist No..__ ...0.411 .
-3A Fi Al OGA ,
Date of Death.theige---' _Z.County..—
'7.1 7 - -7- 4P,4f.:---"t4-
Sex. .... _ Yrs. Color_
lege,or C -
(If city,gives t address '
Cause of Death__ .
Place of B ' (or Recniy _ __ZAVA--... 'yf
lor...
Cemetery .- __Date of B
CiAlficate of Death of____ _ _ ___ _ _77(
(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 SATISPAC Y TOR AS REQUIRED BY
LAW, I have accepted the same for registration,have r rded it in my Local ecord with
the above 8 . 11111 ,and on the basis I H Y FERMLT
(Name ) (
the_ to.Iftligustrlii _71 .wilklitr. _----
the body.
(Un rtaker or erson having charge of corpse) (Inter,remove, oth 'pose of[state how
Dated A f ig.p 2....,,, (Signed) - ...
State (Tuts' Pcerzoniitctisuffiaient for oththeocRecnorzaluoo Interment or C coon) a bodiycit 3,11,,,of thi:Transit Permit(VS No.62)is required. is by "Pleil
ENDO/LSEBOISIT OF .SEXTON OR ','•SO l „in
CAGE OF PREMISES ON WHICH'i t' R-\�
' -. IIENTS OR CREMATIONS ARE i i = e E
bete of _ _9:d.14......_..
t creanat ion)
: Crete� der A> awe of i cruet ema�tcmum,
Person in chaise must return this Permit to Registrar of it District vier*
ISliliN DAYS from above date. If no is in the UNDER
AMER MUST SIGN ABO'YS STATEMENT,w te�uxoss -„ . of the Permit
the words"No person in charge,"and FE.PERMIT .•'.•' THREE(3)
DAYS with Registrar of District in which cemetery is located.'
EXTRACTS OF THEVITAL STATIC Z S. LAW
f 379. Duties tit dertaker. o ease the under, or
having charge of the corpse,shall file a certificate of death-with the re�
of the district in which death occurred and obtain a, 1 or removal
h�aerrmt�irt pr�ir to any orlon of the bodyy. o 0 o The .dertaker shall
deliver the burial perms to the person iii charge of the place . burial.before
ing or otherwise of the bbooddy; or 011111 a ch the remov
40+'" "" re Off nrk,, f,shall be. •n°fa charge
.• p
of
' ,, '; Duties wroygdartollititt in t�Within g•eta If the inter-
mpneea�t or other lisp of the body it made within • ,the word-
ing ot the burial'or removal permit may; limited to a tameat by the
registrar,and over his signature that' a satisfactorycertificate.f death,baying
been filed with him.as required by tow,permission is gran :, to inter remove:
or dispose otherwise of the body,-stating the name. age.sex cause of death,
auer necessary detail upon-the form Prescribed by . commissioner of;
1 NILf No person in charge of any on eqeit
other
Lions are made shall inter or permit the •, ,.t or other'
by y unless it is accompanied °by a t or
in provided. Such person shall ;pemnit
t,or cremation over his signature.SC..,shall return all
_se to the registrar of his district within sev- �dap,�from the
dateii r" of on kthe pre ephis charge of vecord ' rodeei
o e.
the otherwise person,place of death.date of •,
and , of the undertaker; which mead • ,:,at Sy
e,whe 'provided;.that the ,
charge the'wipes,when burying a body in t
ha in charge,shall sign the burial'or hermit gi i
they urm1 acid shall write the face of the ' the'worL _
h and tine Wlau�or rema ? wr three days with
' u�ca Ike to!
SEXTONS and UNDERT s d".: VI law tivetehere
ace liable to aPIPIT � 88.
.
t'be$enTi� Local ,. • are reguirs¢, ,to repdr ttl