Parsons, Robert Form VS.6L NEW;r ¢_O =,H.-0 STATE DEPARTMENT OP HEALTH
C: , BURIAL (OR REMOVAL) PERMIT
gz" This Permit can be signed or;' by the Local Regie'ar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK., ThwI Registered No. C _....._...
Village
Dist. NU.64•2D....Count �� +-t- �-6ity � � ----
/ (If city. ire street address)
Name of deceased..i..Q� ... ,,(1,1.: i,r if3a. Q 71.' Veteran Q
� Single, married, widowed, J (_,If veteran, give name of War)
A)Sex/. , Color,Gtl., or divorced (write a word) �f�,r...Date o� c,.th I..,. , 4.94/k
Age,,. o?„4t Years 1 Mon .� Days Birthplace./ ,. ' 71 •
Cause of Death .. ..... .a.... ,....
.47;‘,..)1.4± 1.•
Certificate was signed y,,. ... M.D.
Address „ .6,-0--4013..-4 - "71 'V.
Place of Burial (or Removal .. .. •
(I boey to be temp a ly4 ,a�prce later)
,f� . /'T
Cemetery .. (/%j Date of Burial. r 19.. . ..
(If body is to be temporarily held,fill in apace later)
Me,Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
i hav�a ?ccepmed the same for registration, have recorded it in my Lo Record with the above stated Registered
rxunW a the basis the I I-IER BY GRANT A PERMIT .. .E-=
.
the ..GT ) to hold temporarily and ( ..:�' rase). . the body.
deryyk�er or ppe�rson having charge o, rpee) nt ,remo �et,orherwise dispose of[state how])
Dated., ....*... J^..., 19., )(Signed .. � ...Gl•
Local Registrar
This Pr emit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Slate (subject to local
cemetery or'other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. '
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMA. 12IT,S ARE
)ate of, . —'�Ll;.�- 19..E
/JAI erment or rematio
;Signed �Ct.�.:.R....
(Person X-i-e
recharge ...l�,,R.. ICY '.... .. ... ��
(Name of Cemetery, Cremators m, etc.) !/
Person in charge must return this Permit o Registrar of his District within
iEVEN (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
he words "No person in charge," and FILE PERMIT WITHIN THREE (3)
)AYS with Registrar of District in which cemetery is located..
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The body of any person
Those death occurs in this state or which shall be found dead therein shall not be
nterred, deposited in a vault or tomb, cremated or otherwise disposed of or removed
'rom or into any registration district,or be temporarily held pending further disposition
nore than seventy-two hours after death unless a permit for burial, removal, or other
lisposition thereof shall have been properly issued by the registrar of vital statistics of
he registration district in which the death occurred or the body'was found. No such
curial or removal permit shall be issued by any registrar until, wherever practicable, a
omplete and satisfactory certificate of death has been filed with him as heretofore pro-
'ided; provided that when a dead body is transported from outside of the state into a
•egistration district in this state for burial, the transit or removal permit issued in
ccordance with the law and health regulations of the place where the death occurred
hall be given the same force and effect as the burial permit herein provided for. No
egistrar of vital statistics shall receive any fee for the issuance of burial or removal
iermits under this act other than the compensation provided in this article.* Provided,
towever, that the commissioner of health shall have power to promulgate rules with
•eference 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
1932,ch.267.)
°See section 390.
§ 379. Duties of undertaker. In each case the undertaker, or person having
harge of the corpse,shall file the certificate of death with the registrar of the district in
vhich 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
,f the place of burial, before interring or otherwise disposing of the body; or shall
.ttach the removal permit to the box containing the corpse, when shipped by any trans-
iortation company; said permit to accompany the corpse to its destination, where if
vithin 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
remations are made shall inter or permit the interment or other disposition of any body
inless it is accompanied by a burial, cremation or transit permit, as herein provided.
inch person shall endorse upon the permit, the date of interment, or cremation over his
ignature,and shall return all permits so endorsed to the registrar of his district within
even days from the date of interment or cremation. He shall keep a record of all bodies
nterred or otherwise disposed of on the premises under his charge, in each case stating
he name of each deceased person, place of death, date of burial or disposal,and name
.nd address of the undertaker; which record shall at all times be open to official inspec-
ion;provided that the undertaker or person having charge of the corpse,when burying
body in a cemetery or burial ground having no person in charge, shall sign the burial
Ir 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
hree days with the registrar of the district in which the cemetery is located.
ire SEXTONS and UNDERTAKERS violating the law relative to the return of
lermits 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.
nen] Raoie.trnr._ ere .an,.,.a.1_ ,.n.lar nennito_ to .an..rt oi..lati..mg tl.ara..i