Austin, Ida _ NEW FORK STATE DEPARTMENT OF HEALTH
` OFFICIAL BURIAL (OR REMOVAL) PERMIT
Jar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District Town,
Age, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTI - OF
LATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered .#...
// Village e
'"Dist. I\To1.Jl4,��County. .. . . or City .- ,„ .._ ,. .
O (If city, give str a rasa)
Name of deceased Veteran
� Ingle, married, wid ed, a (If tars . slue name War)
S olo , , , .. .. divorced (w ' e word).. .. . Date o „ ..l ..
Age ,Y .�,,Months.,�� , 1.��...Days Bi :.1�
Cause of Death. . .... ...
p J,
Certificate was si ..,,,, , . .... M.D.
Address
Place of Burial (. 'v. oval). .. ...
(If body le to be to po cield,811 at*later) ^^��
Cemetery /.... ..--CeaJ-J ,. ... • al Date f Burial ,/ 19?`.lJ,l/�/
(If body is to ., e ..orarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been presented t e, after careful exami-
nation, t same app.-:-,.ir:g to be COMPLETE, CORRECT, AND SATISFACTORY A REQUIRED BY LAW,
I have c pted t.e . e o c. ° ion, have recorded it in my Lo R ord with the tate Registered
Num , on as' e - EREBY GRANT A PERMI
to ) e. B8 J
the.. .. ..,.to hold tempor y _ d d fe dy,
(un or pe v g charge pee) I remo or other oe.> state bow])
Da d //./,,....,19.,. .... (Signed)
- Local R stray
This Permit sufficient for the Removal (and Interment or Creme ion) of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
r
. I
LMENT OF SEXTON OR PERSON IN CHARGE OF
for../'
PREMISES ON WHICH INTERMENTS OR
REMATI NS A E MADE
i
(In.ermer.r
(Person -P.a[M
in charg .. .. ..
(Name of Cemetery, Crentatori 1, tc.) /J
Person in charge must return 'his Permi o Registrar of his District withj/f(
SEVEN (7) DAYS from above date. If no person is in charge, the UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write acr'sa the face of the Permit
the words "No person in charge;" and FILE PERMII WITHIN THi{EF (3)
DAYS with Registrar of District in which cemetery is I:,cated.
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 be found dead therein shall not be
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 disposition
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 of
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
small be given the same force and effect as the burial permit herein provided for. No
registrar of vital'statistics shall receive any fee fcr 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 too 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 premises 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 bodies
interred or otherwise disposed of on the premises under his charg:;, in each case stating
the name of each deceased person, place of death,date of burial ;sir 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 burying
a body in a cemetery or burial ground having noperson in charg., 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 cemetery is located.
SEXTONS and UNDERTAKERS violating the law relative to the return of
permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.