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Nevens, Nettie Form VS.!IL NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT tzr 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 DURABLE BLACK INK Town Registered No._..SL 9 S Dist. No. YW City 6`.4.A.L..County... orr City • (If city, give street address) Name of deceased---.-. , Veteran i ' ' •'ngle, married, wido (If veteran, ive name of War) Sex.."...0 . . or ',.,, „ % divorced (write the word)... �G! 19,..T'f Date of Death.....1. . ... ... Age.... ...? Years Mo s........g .. Days Birthplace Cause of Death •.. .. .. . ... . . . .. ... ..... .. . Certificate was signed by .. '.. ..,.. M.D. s`1 Address . .. " Place of Burial Removal)... t ., _,C� (If body Is to be to lily held,fi space later) / / Cemetery Date of Burial ,l.v / 19.Sig (If body la to be temporarily held,fill in space later) The 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 rec rded i ' my Local Re rd with the abov stated Registered Nu ber on th asis th f I Et1,X y_JG N MIT , ?Og�y/�/1� a ) s the to hold temporaril the body. (IIad er or rson rig charge pee) (Inter,rem a otbe isnose of[state ow)) Dated 19...(, (Signed) Lora Regtatr This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Slate (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 o .. �(��. .. . .19 Interment o �� 144 f (Signed). .._ .. . . .. �' �� (Person i� e�t�`" 7�esx�1 "/ in charge .eG AG[,t�' (Name of Cemetery, Cremat ri In, 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 §375.,. Permitsf.pr burial or removal of dead bodies. The body of any person. whose death occurs in this state or which shall be found dead therein shall:not he interred, deposited in a vault or tomb, cremated or otherwise disposed of or removed from or into an) 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; * * I *.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 vita 'statistics shall receive any fee for the issuance of burial or removal permits under s act other than the compensation provided in this article.* Provided, however, that a commissioner of health shall have power to promulgate rules with reference to tl removal of bodies of persons whose deaths occur on trains, boats or other carriers ngaged in the transportation of persons within this state. •See sect,f'n 390. § 379. t uties of undertaker. In each case the undertaker, or person having cha.ge of thseorpse, shall file the certificate of death with the registrar of the district in which the dth 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 plt 'of burial, before interring or otherwise disposing of the body; or shall attattrh total 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 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 of on the premises under his charge, in each case stating the name of each deceased person, place of death,date of burial or disposal,and name and address of the undertaker;which record shall at all times be open to official inspec- tion. 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. SEXTONS and UNDERTAKERS violating the law relative to the return 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.