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Ford, Elvira Form VS No.61. 10-27-32-25,000(17-2543) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT Sir 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 alter the FILING and acceptance of a COR- RECT AND COMPLETE�Z CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist No Y / Registereul-No County..___._._.. —Bate of Death `��`4 1 3 Tow r-�- - -c. c17Co "; c legei-er ty Sea AgeYrs. C (If city,give street address) /J (� O�') •• Cause of Death (-T /f - /� Place of Burial (or emoval) • (� ~ �^'C"�L`�w �� Cemetery.---- ._.... 'S, `d..__._..._..._... Date of B_u I '/(-- `1 19 •3 egfe Certificate of Death of _ a— . (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 abovestated r Registered N , on the basis t' EBY`�� 'I, E IT . t0 /c/ (a�`(N�bf _...., -. ... dressy , (Un or person?aving charge se) ( eve or�� �' ✓ po 8 Dated_-__--.__..........-._.. ' 19 (Signed) Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject toiota!-cemetery or.other regulations), unless remove/is by common carrier.in which ease a ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTER- MENTS OR MATIONS ARE MADE Dateof._�._._._.._�_... _ .----..._---..... . tg (In merit or Lefreation) (Signed) . f (Person 2 in cbarge)_�f± .. (Name of Cemete 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 WIDER- TAKER MUST SIGN ABOVE STATEMENT,write across the face of the Permit the words"No person in charge,"and PILE PERMIT WITHIN THREE(3) DAYS with Registrar of District in which cemetery is located. EXTRACTS OF THE VITAL STATISTICS LAW baying 37A. Duties of undertaker. In each case the undertaker, or person rig charge rpse,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. * e * 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 tt44ep tination, where if within the state of New York,it shall be delivered to the person 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- ing.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 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. MI. 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 s ven days from she date of interment or cremation. He shall keeps record sti ay,?its irterreedt or otherwise dispr-ed of:,n the premis<a under his charge; earth case stating the name of each deceased person,place of death, date of b-;ial 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. le'ler 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 faro son/de enforced Local Registrars,are required,under penalty,to rem violations thereof.