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Larkin, Loren For•. ..,.tit NEW YORK STATE DEPARTMENT OF HEALTH • OFFICIAL BURIAL (OR REMOVAL) PERMIT tir 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 a CORRECT AND COMPLETE CERTIFFI94ITE OF DEATH, LEGIBLY WRITTEN IN DU LE BLACK INK. Town •ster o... 7 7 / Village / Dist. N... County.. ... .. . .., or City ea ior 0 (If city,give street addre e Name of dec ased... .0. .... Veteran ... /d'. •:le, married, widowed, v (I ran, give nam u) S ... olor . . . divorced (wri the ord) . .. .. . '...Date o P .. i Age Wrs /.'7 onths..,.....r/...D• t irthplac .. . .."... . 4' Cause o Death 'S . f / ✓ �/ /f 4. Certificate was si.,rdolor , .,8 . j I /. . :! i / M.D. `"Illifr ,; • Address Place of Buri. o •; ova `.. "=� ,�'. ir �. . . .. ..� ./.. s� �t'�• (If body is to b tern. : y d,fill ., .. e 1:ter) ` ✓ 9. Cemete v�,�.�� • �• •�. / Date of Burials ...i/2 19,74 (If body is to be - .porarily held,8 in space later) Thu Certificate of Death containing the above stated particulars, having been pre id to me, after careful exami- nation, the sa appearin: to be COMPLETE, CORRECT, AND SATISFACT* •Y AS REQUIRED BY LAW, I have accep O the same •r re,,,". i. • �e r- orded it in my Local Recap,. w the above s gistered Number, ., n the basi he.- . `,3:"s • NT A PERMIT M. °' the ,•�/ /,/� ..to hold tem r 1 d... i. . a) e d (Mid0„....i. pe ng charge ee) f/ / eyDated' 19... .. (Signed). Loeal Registrar This' rmit is sufficient for the Removal (and Interment or Cremation) of a body to any part the State (subj to local cemetery or other revulations i.unless remooal is by enmmnn'tarries. :.. ...6:.1, .... . T.....4 P....... MPS N. R21 .. .... .i....1_ INDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATION RE M• 4 Date of _ 19.r 1 Inte or (Sign ..) aa (Perso • ' in charge) ACtimr"... .... Q (Name of Cem , tc.) Person in charge must return this Permit to gistrar of his District within SEVEN (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 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 § 375. Permits for burial or removal of dead bodies. The body of any person vhhose 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 shall be given the same force and effect as the burial permit herein provided for. No registrar of vital statistics shall receive any fee for ,he issuance of burial or removal permits under this act other than the compensation provided in this article.* Provided, •rlowever, that the commissioner of health shall have power to 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 of 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 hit signature,and shall return all permits so endorsed to the registrar of his district withir 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 charge, in each case stating the name of each deceased 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 inspec• tion;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 buria 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 withir three days with the registrar of the district in which the cetnetery is located. Irr 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 i Form VS 67. NEW YORK STATE DEPARTMENT OF HEALTH ALBANY UNDERTAKER ' S REQUEST TO DISINTER BODY See Special Administrative Regulation 1, subdivision 4, Relating to the Trans- 'portation of Dead bodies by Common Carriers, as printed on the back of TRANSIT LABEL. N. B. Permission for disinterment must ALWAYS be obtained whether the Body disinterred is to be transported by Common Carrier or by other means. I HEREBY REQUEST PERMISSION TO DISINTER the dead body of Loran. Larkin , who died in the* Gity.. (City, Village, Town) of Glens..r'a11�., ..Y. on* J.an..?.,.19.48 , Sex. male , Color or race* white , Age* 73...years, and Cause of Death* C and iac... 'ai.l N eT NOW INTERRED IN Pine le w C em e.t.e.r.y....v.au it (a) The body is/to be TRANSPORTED BY COMMON CARRIER for interment at Camb.r.idg.e Cemetery,t;ambridge.,.11.,Y. (State fully the disposition to be made of body) (Name of place or cemetery) (b) The body is NOT to be transported by Common Carrier but is to be at (State fully the disposition to be made of body) (Name of place or cemetery) i. ..J (Signature of undertaker) f4p/ / • • Dated np.ril...5.th 19...48. Address136 ',`rarre.xt...St. ,Glens teal is ,id.Y. License No. 1338 APPROVAL OF HEALTH OFFICER Dist. No. I HEREBY APPROVE above Request and r mmend at Permission be granted. (Signature of Health Officer)... .. Dated npril 5th 19 48 HEALTH FFICER _ Queensbu I.-Instructions to Local Registrar: Fill out (a) Transit Permit for bodies trans- ported by Common Carrier or (b) ordinary Offical Burial (or Removal) Permit for bodies not to be so transported, in each case writing the word"DISINTERMENT"on the Permit. The data required concerning the decedent may be filled in from the local register or cemetery record. When data can not be obtained write "Unknown" in spaces in- dicated by ("). The Disinterment blank should be filed and carefully preserved in your office.