Sleves, Warren r urns r o a.u.us. a-cur-,,.... .-• .,
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local Registrar(Deputy or Subregistrar)of the Primary Registrz
tion District(Town,Village,or City)in which the death occurred after the FILING and acceptance of a COB
RECT ANDC91 E CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist Not" Registered No.
Count°}em —__- Date of Deat4i ,�¢.3/,4-1
Town,Vil-�
iage,or Cites ��� Senf�/�
ate" ge--o Yrsj' Colo __ .
(If city,giv treet addres ee _
Cause of Death �L�[�l.(� //JJ--
Place of Buri (or Removal) L r�:.l�....JO
Cemeter,-. ... - Date of B , ._rg�;
Certificate of Death ofiXt ,,,,rr J'4"
(Give full name of deceased)
having been presented to me containing the above stated particulars, and, after careful examination
the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED B1
LAW, I have accepted a same for registration,have recorded it in my Local Record,witl
the above sta Regi§ d Number,and on the b is e. I HEREBY GRANT A PERMI'
' C '4
tO�,ll_ � :ken) i Address)
the__( u'ei4010
- i to_ - _ 4� the bod)
(Undertaker'nd or rso having charge 9 corpse) ;•- �••-dispose of[state how])
DaterT� 1y --./� 19,4,3 (Sig. ��
ocal Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of di
State (subject to local cemetery or other regulations), unless removal is by common carrier,in which case
Transit Permit(VS No.62)is required.
ENDORSEMENT OF SEXTON OR PERSON IN
CHARGE OF PREMISES ON WHICH INTER—
���N... .TS OR CREMATIONS ARE MADE
Date of .._ • A_� rg.23
Inter n 41ma n) .
(Signed)... .. __.. .�MM44��11 1._. ..
(Person
in charge)..__._..._._ -,.,e
(Name of Cemetery,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 CO
DAYS with Registrar of District in which cemetery is located.
EXTRACTS OF THE VITAL STATISTICS LAW
§ 379. Dude* 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 transportation
-omRanv; said p4 rout to sccompar.7 t - cc:psc to-its dastina' -a:::� if
within the state of New York,it shall ire delivered to the per us charge
of the place of burial.
§ 380. Duties of undertakers; interment within the state. ff the inter-
ment,or other disposition of the body i to be made within the state,the word-
ing.of the burial or removal permit play 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 otherwise of the body,stati the name, age, sex, cause of death
and other necessary details upon the f m prescribed by the commissioner of
health.
§ 381. Interments. No person i4 charge of any premises on which
interments or cremations are made sha inter or permit the interment or other
disposition of any body unless it is 0 ompanied by a burial, cremation or
transit permit,as herein provided. Sur, person shall endorse upon the permit,
the date of interment,or cremation over his signature, ar,1 shall return all
permits so endorsed to the registrar of his district within see en days from the
date of interment or cremation. He shall keep a record of all bodies interred
4 4_o�herwise disposed of on the re under his charge,in each case stating
^ttF"'t1t..rYi9 fs p trr,� aeht--da -sS.khurial or disposal,
and name and address of the undertaker; which record shall at all tiincs be
open to official in pection; provided that the undertaker or person having
charge of the corpse, when burying a body in au
cemetery or burial ground
having no person an charge,shall sign the burial or removal permit, giving
the date of burial,and shall write across the face of the perxpit the words,"No
nerson in charge, erd file the burial or removal permit within three days with
of t district in which the cemetery is located.
..............„,...Li_ "T . S violating the law relative to the re-
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