Jones, Margaret Form FS.FL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ur This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORREC AND COMPLETE CERTIF, 5)F
DU
DEATH, LEGIBLY WRITTEN IN LE BLACK INK. Town egist No.
i
Dist No.,„, e82.County.../.... . .. oVriCliagitye /3$l irAB
*
/ (If city, give street address)
Name of dadAm:ecea ' d C2/....17/ / / / Veteran
ri
d (IF v . give name 0 far) e
.. ..ee.C. ... ..J .1
14-191rif ' -:le, married, owed,
.. .
Certificate was signe A. — M.D..
Address* ' . d d•
jell
Place of Burial-(or Removal) -
(If body Is to be tempera y e till 1 21 I
..,,.„
Cemetery Date of Burial ..de-C-. (319.7 i
(If body Is to be tem r rily held,fill in spa later)
Thq Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, thesame appearing to be COMPLETE, CORRECT, AND SATISFACT Y AS REQUIRED BY LAW,
I have accep the same for regi ration have r- orded it in my Local Recor it e above d Regist red-
Number, o ebasis Y t • NT A PERMIT
to • • ••••• - •••• ....... ••••
(9dd s
the e xete,"4r /
.., / / / ,... .to hold temporarily and the dy.
(Underta Aeon tia2gilargv,prpse) nte Dated (Signed)
ye th2pdis f[state hoar]
. ... %29
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any psi of the (subject to local
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
•
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of 1' /..•.) 19..`.l..`..1
(Inttrniat or rematio ' ,
(Signed).. M r;,1/2.."i)r,,.r.;: tl, Oi. } C .L
(Person s%, f j(�, /
in charge) d;.f__.r'".� -' /...e 1 L" ke . 'Lk). y.1 r.... ......_....................
(Nam(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 (3)
DAYS with Registrar of District in which cemetery is located.
EXTRACTS OF THE VITAL STATISTICS LAW
.0 . § 375. Fermitjfor u, •or remov+ 19f dead bodies. The body of any person
whose death occurs in this state or whicli shill-fie found dead therein shall not be
interred, deposited in a vault or tomb, cremated or otherwise disposed of 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 death 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 burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
shall be given the same force and effect as the burial permit herein provided for. No
registrar of vital statistics shall receive any 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"Qerson in charge
of the place ofttrial, before interring or otherwise disposing of the,body; or shall
attach the remo al permit to the b*cunt the Corpse, whereshippeol by-any.trans-
portation comp y; said permit to accom y the corpse to its destination, where if
within the state Of New York, it shall be.d vered to the person in charge of the place
o burial.
§381. Int rments. No person in charge of any premises on which interments or
cremations are ade shall inter or permit th interment or other disposition of any body
unless it is acc mpanied by a burial, cre tion or transit'permit, as herein provided.
Such person sh 1 endorse upon the permit, he date of interment,or cremation over his
signature,and all return all permits so a 'orsed to the registrar of his district within
seven days fro :the date of interment or cr ation. He shall keep a record of all bodies
interred or otherwise disposed of on the pr mises under his charge, in each case stating
the name of deceased person, place onam
e
date of burial or disposal,and
and address of he undertaker; whirch reco d shall at all times be open to official inspec-
tion;provided at the undertaker or pets n having charge of the corpse, when burying
a body in a ce , tery or burial ground having no person in charge, shall sign the burial
or removal pe it, giving the date of b rial, and shall write across the face of the
permit the words "No person in charger and file the burial or removal permit within
three days withthe registrar of the distrirt in which the cemetery is located.
SEXTONS and UNDERTAKERS violating the law relative to the return of
permits are liable to a penalty of NOTILESS THAN FIVE DOLLARS NOR MORE
Tit AN FWFTY'DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.