Lauder, Edith Form vs.si. _ NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar This Permit can be signed only by the Local Registrar (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 CERTIFlCI TE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. ,�" /
Dist. No.7'ii d ' bCoun ... --- 0'� ti illag e � •-.
P.
4 / llr ifV (If city, give street address)
Name of deceased .6 ��`t / '
to :innie, r,,:rr ied, widowed, � 0,1, eo p f1/ c�
Sex Color r divorced (write the word) ""I Date of )cat �e". /l 19 ( 4/
Age sr 6' Years b........ ).l,nli'' .. 43 Days Birthplace. l r k.
Cause of Death ,_d- ' "Y
Certificate was TImo• ,�•. i�1.D,
Address. ���, /��t�i
Place of Burial (or Rernov I )...2 Co .,,
(If body Is to be po : e , '[ iir^eyhtter)'
Cemetery. / • Date of Burial l ''/ / 4' 19#s1
(If body Is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me. after careful exami-
nation, the same appearing to he COMPLETE, CORRECT. AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Nu e don tobas thereof I H • BY GRANT A PERM a
4#4440
.e.%,, ft, , ....,y
•
e (A dress)
the... ��'� to hold tempo a ily and the body.
(Undert keno person awing charge�9y r ) (Inter, )u�iipie,_or ofq h�lse ii- of w])
Dated f � 1 19..T.- (Signed) !/" / '
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) 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.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONSARE MADE
Date of.... . . ••• a.;4410......R.,e.,- ZIX ‘ 19
4 (Interrnent or n)
(Signed)(Person /1•Sreigey.40e.mees.,-; G../1".Z-Arc,
[II ch argex...„.4;40tier% ' .7 ;- 5/...W. C.4.44-4.-.L.--.6.4 i.......
(Name of Cemetri4ematori , . 4.-- ..ge e
. .
.-
Person in charge must return this Permit to Registrar of his District within
SEVEN (7) DAYS from/above date. lf,no person is in charge, the UNDER-
FAKER MUST SIGN ABOVE STATE7)ENT, write across the face of.the Permit
:he words "No person in charge,"Ind FILE PERMIT WITHIN THREE (3)
SAYS 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
whose death occurs in this state or which shall be found dead therein shall not be
interred, deposited in a vault or tomb, Lreitated or otherwise disposed of or removed
from or into any registration district,or be tenfporarily held pending further disposition
more than seventy-twO hours after death,:unleg's a permit for burial, removal, or other
disposition thereof slll have been properly psued by the registrar of vital statistics of
:he registration district in which the d hlicciirred or the body was found. No such
)urialcti.
or removal permit shall be issu b§ any'registrar until, wherever practicable, a
otriplete and satisfactory certificate of d ' dr has been filed with bins 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 btiriat, the transit or removal permit issued in
tccordance with the law and health regulation;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
)ermits under this act other than the compensation provided in this article.* Provided,
sowever, that the commissioner of health shall,have power to promulgate rules with
-eference to the removal of bodies of personsiwhose deaths occur on trains, boats or
)ther carriers engaged in the transportation of persons within tins state. (Am'd by
L.. 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-)f death with the registrar of the district in
which the death occurred and obtain a burial or removal permit prior to any disposition
)f the body.*** The undertaker shall deliver the burial permit to the person in charge
if the place of burial„before interring or otherwise disposing of the body; or shall
tttach the removal peirhit to the box containing the corpse, when shipped by any trans-
)ortation 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
)f 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
mless 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
;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 ttie premises under his charge, in each case stating
he name of each deceased person, place of death, date of burial or disposal,and name
ind address of the undertaker; whichrecord shall at all times be open to,official inspec-
ion; provided that the-undertaker or,person having charge of the corpse,when burying •-
t body in a cemetery or burial ground having no person in charge, shall sign the burial
)r• removal permit, giving the date of burial, and shall write across the face of the
termit 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.
trv-SEXTONS aed UNDERTAKERS violating the law relative to the return of
iermits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
CHAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.
-ocal Reaistrars, are reauired. under nenaltv.. to renart vinlatinn. thpr.,4