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Blormberg, Rose Form VS No.61. 10-27-32-25,000(17-2543) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT B•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 CO LETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist No ,,�� '' `` 0/ Regist Ne,olor o County_...111.1�./f� ���� L' r—Date of Death.,, eY 13 3 .eerlr,mil- - Sex`� Age_ `r Yrs. . izge,or City' �/� >',�,�-_ 401... (p,.M (If city,give street address) //`^A,c.4.`^�__ �a Q Cause of Death t J • Place og Burial (or emovai)...._ •...-1_"�! ... 7utia D uria.1- (/ - • Ceme�y..-.:__....: ......____.._"'��:'. ._.._..__._. Date of E ��7 i Certificate of Death of . ._P a--1-42._ (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 BY LAW, I have accepted the same for registration, have.recorded it in my Local Record with the a atered Number,and on the basis f 1 HEREBY G��41T i�t� cx�'1GG ( " a of underta (Address) ; the. to.---•-- Cie body. (Under or r have-n 'charge of51rP$� ( r,rempve of e D Dated F 19 J ,,/ (Sign 0744.4e Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject tocloocalccemetery.o other regulations), unless remove/is by common carrier,in which case a ENDORSEMENT OF SEXTON OR PERSON TN' CHARGE OF PREMISIES ON WHICH INTER- MENTS OR CREMATIONS ARE MADE Date of. 45 re — Intermc t cc cremation) (Signede. • eaft...1:4e14•241 - -- , _ (Name of Cemetery, niatorium,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- TAXER MUST SIGNABOVE STATEMENT,write across the face of the Permit the words"No person in charge,"al FILE PERMIT WITHIN THREE(3) 'DAYS with Registrar of District in wh h cemetery is located. EXTRACTS OF THE VITAL STATISTICS LAW I 279. Duties of undertaker. Is 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 company: eaid permit to accompany. the corpse to its destination,.where if within the state of New York,it shall be delivered to the pe."son in charge of the place of burial. 880. Duties of undertakers; interment within the state. If the Inter- ment,or other disposition of the body is to be made within the state,the word- imeof 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 otherwise of the body,stating the name,age,sex,cause of death, and other necessary details upon the form prescribed by the commissioner of health. I AFL 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 on the premises under his chfifee,in each case stating the name of each de nosed person,place of death, dadt of burial or disposal. and name and address of the undertaker; which record shall at all 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. Mr'SEXTONS and UNDERTAKERS violating the law relative to the re- turn 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.