Putnam, Seward Form VS.St NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tar 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 CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN RABLE BLACK INK. Th'wg. Registered No.
/ �j Village &,./4,44re...eC2
...(` . /�Dist. l�Tgl�C County. r... �r Eity—.. • ,�.z�=.{Q
-� JD/ (If city,give street address)
Name of deceased. ... .. . . .. .. . . .. ,.., ,,,. 4.s--e-t� Veteran
Single, married, widowed, ( `"""' give ""'$j° Wsz)
S�.. Color.... . .., or divorced (writ3arordy/ .. Date o ea ... . ��CC rP
Age.. Yeas ,Months j Days Birthplace ..
Cause of Death f�-'
-
Certificate was sign M.D.
Address ,
•
Place of Bur Removal) $.�, ,,,
(If body is to b orhrily held, fill 1 eAve later)
Cemetery it ..... . Date of Buria 1 27 19 4/q
(If body is to be temporarily held,fill in pace later)
Thu Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, 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 above stated Registered
Numb ,.and on the sis thereof I H1 G NT ER T e _ _ ,
(Name)
Vie .,"" .;/-4teeet?//I* 7
� __ (Address)
the
to hold tempor rily an #' .... the body.
make or p charge o c se) r,remove,or se&noose a how
Dated. /y 19..,E (Signed) `.r
.al Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a 'to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a ransit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE Of
PREMISES ON WHICH INTERMENTS OR
CRE A ONS A EAA_DE 4
Date !: .aal 2 ! 19
(Interment o rma ory
(Person -
in charg g,„,Ifist 44—* •
(Name of Cemetery, Cremat turn etc.)
Person in charge must return this Permit to Registrar of his District with
SEVEN (7) DAYS from above date. If no person is in charge, the UNDE}
TAKER MUST SIGN ABOVE STATEMENT, write across the face of the Perm
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 removal of dead bodies. The body of any persi
whose death occurs in this state or which shall be found dead therein shall not
interred, deposited in a vault or tomb, cremated or otherwise disposed of or remov
from or into any registration district,or be temporarily held pending further dispositii
more than seventy-two hours after death unless a permit for burial, removal, or oth
disposition thereof shall have been properly issued by the registrar of vital statistics
the registration district in which the death occurred or the body was found. No sup
burial or removal permit shall be issued by any registrar until, wherever practicable,
complete and satisfactory certificate of death has been filed with him as heretofore pr
vided; provided that when a dead body is transported from outside of the state into
registration district in this state for burial, the transit or removal permit issued
accordance with the law and health regulations of the place where the death occurri
shall be given the same force and effect as the burial permit herein provided for. Is
registrar of vital statistics shall receive any fee for the issuance of burial or remov
permits under this act other than the compensation provided in this article.* Provide
however, that the commissioner of health shall have power to promulgate rules wi
reference to the removal of bodies of persons whose deaths occur on trains, boats
other carriers engaged in the transportation of persons within this state. (Am'd I
L. 1932,ch.267.)
•See section 390.
§ 379. Duties of undertaker. In each case the undertaker, or person havii
charge of the corpse,shall file the certificate of death with the registrar of the district
which the death occurred and obtain a burial or removal permit prior to any diepositii
of the body. ***The undertaker shall deliver the burial permit to the person in chari
of the place of burial, before interring or otherwise disposing of the body; or sha
attach the removal permit to the box containing the corpse, when shipped by any tran
portation company; said permit to accompany the corpse to its destination, where
within the state of New York, it shall be delivered to the person in charge of the pla
of burial.
§ 381. Interments. No person in charge of any premises on which interments
cremations are made shall inter or permit the interment or other disposition of any boi
unless it is accompanied by a burial, cremation or transit permit, as herein provide
Such person shall endorse upon the permit, the date of interment, or cremation over t
signature,and shall return all permits so endorsed to the registrar of his district with
seven days from the date of interment or cremation. He shall keep a record of all bodi
interred or otherwise disposed of on the premises under his charge, in each case.statii
the name of each deceased person, place of death, date of burial or disposal,and nar
and address of the undertaker; which record shall at all times be open to official inspe
tion;provided that the undertaker or person having charge of the corpse,when buryii
a body in a cemetery or burial ground having no person in charge, shall sign the bur
or removal permit, giving the date of burial, and shall write across the face of t
permit the words "No person in charge," and file the burial or removal permit with
three days with the registrar of the district in which the cemetery is located.
a'g SEXTONS and UNDERTAKERS violating the law relative to the return
permits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MOF
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforce
e • . • 1 --- '-- -----'�— -- -----� ----'-�'--- .,_. _ [