Bergeron, Elizabeth ' it
i
'-.-- -- '.•. (17497 )
TRANSIT PERMIT
--440111100""im'amm—NEw YORK ----- ___ _ • _ _ ,j,&
STATE DEPARTMENT OF HEALTH
ALBANY '.
ISEP A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany each
dead body transported by a common carrier.—Rule 1.
UNDERTAKER'S CERTIFICAT
Wrrellg truertify that the accompanying dead body of.csu -
.c, .who died in the. of ,
..?.
azeLzia (Ca 'li V ge or Town) swir.41_
1.1 County of , State of New York, on-ill-12-C-A /.2 191/455, Sex •• ' Marned
-0 ,Color or race................. -)g . .., 4ge....7.137yeats.....1--...months-1....—clays, •rthplace...&-...... ..1. -.../..i.w...L. , and Cause of
i Death..2e. - - ../ ,....A.'.‹.-1."2---' prepa(ed for transportation
-7 , ArtieekbLog
i: strictly in accordance *th RU as printed with this blank. Certificate was signed by
-ca
, . 4 ., (State number of Ru!!), ..... e of shipment..........—................
s,,ipment. W.44,••'., .., Point o destination
a --- •
os ,(Signature of Undertaker)
"4 Dated. .;.....01...... - . 9 'ISK- 3 Address. 17
*Cross out words not applying.
tl PERMIT OF LOCAL REGISTRAR
Dist. No. ,_g4/7Registered No. igt 7
,
Date of issuance-. ...-....-/...0...-......--........19A-.5
A satisfactory Certificate of Death for above decedent having been filed and reco ded in my office PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF AE BODY
• ture of Local egis‘ -............ _..._.
..
Local Registrar of the.... ----.. o. , ounty
(City ' wn
(
State of New York.
(
fe,P Only the L Registrar (Deputy or Subregistrar) may issue a Bu • 1 Removal or Transit Permit
2P Detach here and give part above to escort or attach to waybill if shipped by express
a v pit
i.
ENDORSEMENT OF SEXTON OR PE1t2SON IN CHARGE OF PREMISES ON t1
WHICH INTERMENTS OR *REMATIONS ARE MADE
ilwiftr
Date of-- was.........;........ F ze ...__ 19
(Interment or_cxematien) / i ,
(Signed) ......._...____. .I -' _'
(41 Person in charge of _... _ _.._.._.._ 6 _. _
(Name of Cemetery, Ccem �atesiirnetc.) —'
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 UNDERTAKER 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 FROM VTkAL 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 permit to the person in charge of the place of burial,before interring or other,
wise 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 the State of New York, it shall be delivered to the
person in charge of the place of burial.
§ 3$0. Duties of undertakers; interment within the state. If the interment, or other disposition of the body is to be made within
the state, the wording of the burial or removal permit may be limited to a statement by the registrar, and over his signature, that a
satisfactory certificate of death, having been filed with him, as required by law, permission is granted to inter, remove or dispose other-
wise of the body, stating 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 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 311 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 or removal permit within three days with the registrar of the district in which the cemetery is located.
leF 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. Local Registrars are required, under penalty, to report violations thereof.