Loading...
West, Alice Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tr 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 CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No. Dist. N'eS.6.,7 County 4"...66/ )//41•••01 (If city, give str dress) Name of deceased .e-AL.4..—t ... .,12...t,th Veteran t Single, married, widowed, "/ ,......e!eran, give name of War) SeX.:91... ... .....Colo: V ...or divorced (write,th word)lef.ad Date otpeath../1 ...es.. OS Age )fif 1-1. Years ' 7 Months. ../... .Days _ hr: ,,e1Birthplace../././..0 Cause of Death yx, _,..• • ' - , Certificate was signed by ir's'ir):134t. ti-1-'w Le(r---W4 . M.D. Address .. &--64q '94$41044o Place of Burial or Removal . . (If body is to be t)1fl5rar117 eld, 1 n ace late ___ Cemetery 4t..,. Date of Burial 7 1( ,7 4( 19.1i2 (If body is to be temporarily held,Jill in space later) The Certificate of Death containing the above stated partic lars, having been presented to me, after careful exami- nation, the same appearing to b- COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I hay accepted the e for egAllett tion, have recorded it in my Local Record with the above stated Registered Num on the st,• . BY GRANT A PERMI eta--- (Na. the....../.4../ - (lin rss•ving C. rge of corpse) 4 ,iicgioe to hold tempor ' nd odse.,e )..ecyratoc, 44211tervoz,oeer dispose of[state how]) body. Dated 19./d-- (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 ranulatinnal.unless removal Is hi,commnn carrier_ :a Mel. r••• • T....4 P......4 (VS No. 62) is reauired. _.eill ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of _ e.... 19/.1.?. i3 (Intermeer crematio (Signed) . . _- - (Person G�/ t A in charge) ii—,44 -- t• .. .7‘.Ca it—S7 fb.._. .t.. (Name of Cemetery, Crematorium, etc.) i 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 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 whose 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 and 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 dth has been filed with him as heretofore pro- vided; provided that when a dead body ii transported from outside of the state into a registration tlistri in this state for Initial, the'transit or removal permit issued in accordance with t, law and heath reguations of the place where the death occurred suit be c.: ...+t e, ante farce am eft`ect. " 't `*hurigp rlrtit herein provided for. No registrar of vital atistics shall receive ny fee for the issuance of burial or removal permits under this fact other than the compensation provided in this article.* Provided, however, that the..commitioner 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. (. ni'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 registrlr 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 or 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 his signature,and sha;i return all p.ctsrits so e,;.dorsed to The regictar of his district within seven days from the date of interment or cremation. Ile 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 c>f 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 burial or removal permit, giving the date of burial, and shall write across the face of the permit the words "No person in charger and file the burial or removal permit within three clays with the registrar of the district in which the cemetery is located. to SEXTONS and UNDERTAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MO THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforc Local Registrars. are required. under./penalty. to report violations thereof.