Alden, Robert Form VS.6L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
t This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (T. n,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTI C.t •F
DEATH, LEGIBLY WRITTEN DURABLE BLACK INK. Re �stered No.... ...
// Town G
Dist. No�i00�..County. ... clyeitaft.„0
Village... .. .... �.• - .�. . ..
/. or (If city-.;.ri�-r st reot :uifl re::.j /
dame of deceased ,,, ` /.
Sea4� ���,�Single, married, w': ed, f G /.
Co or divorced (write e word) ... . - ...-Date oil )cf, :. .. .1(.4.7
Age Y e .Mot s (�y�,...Days Birthplace.. *e ' •. . . .. ..
a.
Cause of Death. . . . . .. �. !,.. ,, ��/�• / ..+
Certificate was si ne b # , , / �� "frt.,' iY1.1 .
Address....`.... ' POW r ,
Place of Burial or Remov / , , 1.� ~e �, 4,, '
(If body is to be to ril 1•� i.`Mace later) .oCemetery .,.. 1 • . Date of I;urial... ,/ d " 9 19y.1
(If body Is to emporari s ie P, lill n spare later)
The Certificate of Deacontaining the above stated particulars, having been present /to me, after careful exami-
nation, the same appering to be COMPLETE, CORRECT. AND SATESFACTORY AS REQUIRED BY LAW.
I h e c epted the same for re "stration, have recorded it i my Local Record with the above stat d egistered ,
Nu b on T g• " :'- Aher-� I HERE' '','A / ii, .-
% — r �`' .,� �,.a. fir. .
t j ,. , f CIA. i t
the .• / to hold temporarily an�.... -i the dy.
er aker or per n Lac'i char a se) fe 1 (I remove,or other -p4• die •f -till()
Dated® . s �4 1'?... (Signed1 /„ . • !0
`' Local Registrar
This P-/it is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State ubject to local
cemetery or •ther regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) i required.
r i
i
• ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
, .
CREMATIONS ARE MADE
! Date oLorne: ,,,g1P: 19 V/
(Signe • C...t0
(Perso •
in charge) .e;-....Afe..44, 14i. 47:4••e2e:0".° al;"'
(Name of Cemetery, ,'rent.tt,,ritim, c c.i
Person in charge must return this Permit to Registrar 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 whiclocenietery is located. .
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The body of any person
whose death occurs in this state or which shall he found dead therein shall not be
interred, deposited in a vault or tomb, cremated ti or ol:,krwise disposed ot or removed
from or into any registration district,or be temporarily held pending further disposition
more than seventy-two hours after death unless a puntlit for burial, removal, or other
disposition thereof shall have been properly issued by the„registrar of vital statistics of
the registration district in which the death cecurred 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 fled with him as heretofore pro-
vided; provided that when a dead body is transported I rum 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 as the burial permit herein provided for. No
registrar of vital statistics shall receive any fee for the issuance of burial or removal
permits under this act other than the compensation provided in this article.* Provided.
however, that the commissioner of health shall have power to promulgate rules with
reference to the removal of bodies of persons whose deaths occur on trains, boats or
other carriers engaged in the transportation of persons within this state. (Am'd by
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 in
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 charge
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 if
within the state of New York, it shall be delivered to the person in charge of the place
of burial.
§ 381. Interments. No person in charge of any prehnises on which interments or
cremations are made shall inter 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 shall return all permits so endorsed to the registrar of his district within
seven days from the date of interment or cremation. He shall keep a record of all b.dies
interred or otherwise disposed of on the premises under his charge, in each case stating
the name of each deceased person, place of death, date of burial or disposal,and name
and address of the undertaker; which recordIshall at all times be open to official inspec-
tion; provided that the undertaker or person having charge of the corpse, when burying
a body in a cemetery or burial ground having no person in charge, shall sign the burial
or removal permit, giving the date of burial, and shall write across the face of the
permit the words "No person in charge," and file the burial or removal permit within
three days with the registrar of the district in which the c metery is located.
tT SEXTONS and UNDERTAKERS violating the I w relative to the return of
permits are liable to a penalty of NOT 1.ESS THAN FIFE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The low will be cap,ced,
Local Registrars, are required, under penalty, to repo it violations thereof.