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Belle, Treffle Form VS.6L 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 CERTIF DEATH, LEG LY WRITTEN IN DU LE BLACK INK T�� Registered No..... �/ / Wilage Dist. N 4 01.County. or y // (If city, give treet address) /� 1`'E S� Cit Name of deceased .0 .. ... ' Vetera i le, married, widowed, (lf veteran. give name of War) , ' Color or divorced (write the word) Date of Death 19.. Age '17 Years , Month ..r...»» ays Birth p. .. U lace.. . .... ..... .. �- Cause of Death ; . . Certificate was signed by — .... . n'^ ©. M.D. Address 7"fileal'&- Place of Burial (or Removal) ?'� (If body is to be tem ra y he , s 1 ter) ~ Cemetery . . . later) • Date of Burial re•-4-•elei 1 19, ` (If body is to be to or ily held, 1 in space later) The Certificate of Death ontaining the above stated particulars, having been presented to me, after careful exami- nation, 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 the above stated Registered Number,,,ad• the basis tllgeof I HEREBY G NT A PERMIT to /.�`' re Address) the to hold temporarily and — the body. (Uncle er or r n having charge of corpse) r,remove,or otherwl dispose of_Estate how]) Dated' . .... ...2....p 19 (Signed) e 7 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 nr ether resulatinnal_unless reeen.Ml is Ay,nom...s.wn wnrrier_ ... ...6...1. ..... . T.....A P.....:• ivc N.. A91 i. ...n..».d_ , ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MA L Date of '...............19 1r/ (Interment or cremation (Signed) V / (Person '` in charge) N(�Kp..i.. l. ......... .. . fi to eter , C'r-itud-d"" 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 STATE:.IEN T, 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 an 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 ally tee for the issuance of burial or removal permits under this act other than the compensation provided in this article.* Provided, however, 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 destinati n, 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 shall return all permits so endorsed to the registrar of his district within 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 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 or removal permit within three days with the registrar of the district in which the cemetery is located. itV 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 enforce - t,..al Reet:.►..nr0 sr. wo......od .....lo. ..o..alto In .e.,.,.r ..:..lnti....a ri.e..e..i