Fuller, Seymour term vs.M. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Q This Permit can be signed only by the Local Registrar (Deputy por subregistrar) of the Primal,MA a.stT ti
E on District (To
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND:O ��
)EATH. LEGIBLY WRITTEN IN DURABLE BLACK INK- Town e8i8t CERTIFICATE E OF
Village
arr°en oton Creek
Dist. No County � or City Y
(If city, gietreet address) •••••••.
rriour Fuller Jame of deceased �Q.k Veterat... .... ='.o
Single, married, widowed, ....................... ....... . • ; )
• , ale r21te ,,lao;iir'ec Date of Des ...am--;
of
sex Color 9 or divorced (write the word) ; ••k.................19
tge Years Months Days Birthplace............•......z;e e
c Jecon ensation H- crtensive Heart .isle 3e
:suss of Deathu�a:4i�e, � ? Y.�- .�. n '1" .... ........ ...
:ertificate wad signed by l',ax Rothman .h e t r 4—
Address .,arrens burg, New-'or`k. T
J.
'lace of Burial (or Removal) lQwn of 4ueensbury ,. :;.A. •;•,r
If body is to be temporarily held,till in space later)
:emetery I,ti -1e r:' a n Date of Burial i,a110 , 19 49
If body is to be temporarily held,fill in space later)
I°he Certificate of Death containing the above stated particulars, having been presento me, after careful exami-
ation, the same appearing to be COMPLETE, CORRECT, AND SATISFAC!'ORY) REQUIRED BY LAW,
have accepted the same for registration, have recorded it in my Local Record wide above stated Registered
dumber, and on the basis thereof I HEREBY GRANT A PERMIT
Orton a JeClos cey :darrensbur,New York
le Undertaker (Name) inter teas)
to hold temporarily an the body.
(Undertaker or person having charge of corpse), nter, r?n1o�or other disooee of[state howl)
)ated - ca 4?:1... , 19 � (Signed) ' f"
r Iarar
This Permit is sufficient for the Removal (and Interment or Creme of a body to y pof the Slate (subject to local
smetery or other regulations),unless removal is by common carrier, in which case a Transit PerzVS No. 62) is required. .
ENDORSEMENT OF SEXTON 1'OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of hrls CX.Aor../h
, 19 if.?
(Inte cot
(Signed) 1 -...../4111-1rt.svlortIVY4.
in charge)(Person
(Name of Cemetery,'Crematorium, etc.)
Person in charge must return this f'ermit to Registrar of his District within
SEVEN (7) DAYS from above date. I. 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
§ 375. Permits for burial or remov4 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, creinated or otherwise dispose410f or removed
from or into any 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 dead, has been filed with him as heretofore pro-
vided; * * * *.When a dead body is transported from outside of the state into a
registration district in this state for buril, the transit or removal permit issued in
accordance with the law and health regtilat ons of the place where the death occurred
shall be given the same force and effect as the burial permit herein provided for. No
re istrar of vital statistics shall receive aJ fee 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.
•See section 390.
§ 379. Duties-of undertaker. In each case the undertaker, or person having
cha,ge 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 destination, 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 rzi„pcx,,,i.4,.ir.torrnent or other clisnriciticm°Lanvin-Ay
"emits so endorsed to the registrar of his district within
shall return a P
tgligpersonnsdhall endorse uoiol
signature, prenises under his charge, in each case stating
afrom the date of inter or crenation. He shall keep a record of all bodies
the
seven days
n, place otcleath, date of burial or disposal,and name
interred or
the name of ;kwhrich recor shall at all times be open to official inspec-
°teahecrhwidseecedaisredsedper°so
or persohaving charge of the corpse, when burying
and add
re ded that the underta s.s.of the undertaker
t eound havl; no person in charge, shall sign the burial
tion;Pr°
a body iis,ilalceetnretnteit7giving
or buria. r, bud, and shall write across the face of the
t..e. i file the burial or removal permit within
1, ground
of
or rerriova
district which the cemetery is located.
Permit the gistrar of
*th the re the
wpords"No person in charge,"
three days v." TAKERSolating the law relative to the return of
a uNDER —T IS THAN FIVE DOLLARS NOR MORE
evn raite SEXTONS arean
RS FOR
liable to a Penalti °I NO
HA
Flf OFFENSE. The law will be enforced.
FIFTY under pity, to report violations thereof.
1-vt A N Fo-_'' __ -... rectuirixf,