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