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DeFour, Edith NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT .65IrThis Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registra- tion District(Town,Village,or City)in which the death occurred after the FILING and acceptance of a COR- RECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. / Dist No 17160 el./_ Regis ed No. _ County ��y�-��—�-� to of Death. �I 3 19 a Z Town,Vil- i l lage,or City Sex Age _ Yrs. Color.. a-2 f city,givett address) (Or Mo��e%!2 Cause of Death Place of Burial(or Removal) - - CemeteryJ= tg-e--32_ - -_-----Date Burial / 19.3 Z Certificate of Death of �i � /2-� ive full ame of deceased) having been presented to me containing t a ove stated particulars, and, after careful examination, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registration, have recorded it in my Local Record with to e 21 /p}/sve s Re it-fie tu ber,and on the basis thereof I HEREBY GRA��jT�oPG; EI T t ame ndert er) (A ess i the to the body. (U er ker or person having charge oc.,/._ ( remove,or other(i a i of st to n Dated-.- - J Iq c3/� (Sign .• �c L�e�Local Registrar his Permit is sufficient for the Removal (and Interment or Crem tion) 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 INTER— MENTS OR CREMATIONS ARE MADE Date of 444_ 31 fir. rq,. ,:szitc..„, Interment or nremation)(Signed) "1 ��° r-�.. __.... (Person /I, in charge) ._.. r!�!�' -!!�: (Name o Cemetery,Crematorium,etc.) Person in charge must return this Permit to Registrar of his District within SEVEN(7)DAYS from above date. If no person is in charge,the UNDER- TAKER MUST SIGN ABOVE STATEMtNT,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 which cemetery is located. EXTRACTS OF THE VITAL STATISTICS LAW i 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 sliver the burial permit to the person a charge of the place of burial, before interring or otherwise disposing of t body; or shall attach the removal permit to the box containing the cot ttiti-.....:._p:.4 by eny ...e._ery..tatino 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. §380. Duties of undertakers; interment within the state. If the inter- ment, or other disposition of the ody is to be made within the state,the word- ing.of the burial or removal permit,jtay be limited to a statement by the registrar,and over his signature that d satisfactory certificate of death,having been filed with him,as required by la*,permission is granted to inter,remove or dispose otherwise of the body,stat Ig the name. age,sex,cause of death and other necessary details upon the form prescribed by the commissioner of health. § 381. Interments. No person In charge of any premises on which interments or cremations are made sha 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. Sur:h 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 s.sall keep a record of all bodies interred or otherwise disposed of on the premiss under his charge,in each case stating the name of each den-aged person,place of death, date of burial or disposal, and name and address of the undertaker; which record shall at all times be open to official inspection; 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 pr removal permit within three days with the registrar of the district in which the cemetery is located. __— Sr'SEXTONS and UNDERTAKr7RS violating the law relative to the re- turn 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. Local Regisffikrs,are required,under penalty,to report