Parker, John L Maas •,J L•V.VS. 1-1V•VV V 4L1-YJV1,
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
SW-This 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 LETE CERTIFICATE OF DEATH,LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist No... / ) > Registered No
County v -_._. Date of Death....._'_•- . ....... ..2.3.-t9.-3
Town,Vil- '"%._`� /A(
lage,or City Y lli nt_..._I Age_.,.:,_�Yrs. Colo VV '
(If city,give street address)/ r )
j ., r Y i.A (pr,it.-
Cause of Death ,e ,...r Y t.!1:4" - 'C -L -f, �u V i%�'
Place of Burial (orj(emoval)_ _ ---. - .%�� - __.._.._-_-._•.-.•-
�a _
�'-.4 F _ Date of Burial-__ / o..-T
Certificate of Death of ' `=�° 7 �`e�--
(Give full name of deceased)
having been presented tote containing the above 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
the above ted egisterpd Number,and on the basis th of I HEREBY GRANT A PERMIT
,
yVAame o dertaker) ess) r
the.... _C1LA(. � = fl= to...'� r! � _._.rL- the body.
( ertake r perso haven charge o�j-r�rpse) nter a ove oth dispose statexiowl)
Dated _ .. _ 19,5 (Signed) Eyd -V-Z!-r `.
Local Registrar
is 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 regulations), unless removal is by common carrier, in which case a
Transit Permit(VS No.62)is renuired.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER-
MENTS OR CREMATIONS ARE MADE
Date of _ _ re_._--
'+ (Interment or cremation)
(Signed)•„• ._�_ .--- ___ —
-
(Person
in charge) —...... —
(Name of Cemeery,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 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
§ 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 permitto 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 transportation
company; said permit to accompany the corpse to its destination, where if
within wee state of New lark,it s:.b4rbe 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 body to be made Within the state,the word-
ing of the burial or removal permit may be limited to a statement by the
registrar,and over his signature that asatisfactory certificate of death,having
been filed with him,as required by lad,permission is granted to inter,remove
or dispose otherwise of the body,statiig the name, age,sex,cause of death,
and other necessary details upon the lbrm prescribed by the commissioner of
health. i
§ 381. Interments. No person iu charge of any premises on which
interments or cremations are made sh inter or permit the interment or other
_disposition of any body unless it is companied by a burial, cremation or
-transit permit,as herein provided. Su h person shall endorse upon the permit, •
the date of interment,or cremation• -er his signature,and shall return all
permits so endorsed to the registrar of-sis district within seven days from the
'date of interment or crr:r n. He keep a record of all bodies interred
,rr,...y 4icrAnsea of on the r a._ under his charge,in each case stating
the same of each d•tea:•d r,_�n, ,1a of death, date of burial or disposal,
and name and address of the unde s; which record shall at all times be
pes to obi inspection; provided ;,at the undertaker or person having
charge Olathe rpse, when burying a ,ody in a cemetery or burial ground
having no person in charge,shall sig the burial or removal permit giving
the date of burial,and shall write actos, the face of the permit the words "No
person in charge,"and file the burial of removal permit within three days with
the registrar of the district in which ttis cemetery is located.
--..„--
litir SEXTONS and UNDERTAKERS violating the law relative to the re-
turn of_permits are liable to a penalty;if NOT LESS THAN FIVE DOLLARS
NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The
law will be enforced. Local Registrars,are required.under penalty,to report
violations thereof.