Braverman, Millie rvrau•o nu,va• o o aavv,vvv jai- G/ -
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Or'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 ani acceptance of a CORRECT AND COMPLETE CERTIFICATE
OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
Dist. No.56O1 Registered No 2772.
Town, City of Glens Falls, N. ".
County.. a Village
or City (If city, give street address)
Name of deceased -P& LL
Single, married, widowed,
Sex Colo
Years / Soir divorced (write the word)` Date of Death.. �la7i /, 193V
Ag (7 Years / Months..... - d Days Birthplace....
Cause of Death / 2 � �
Certificate was signed by.... .b . ..W ... M. D.
Address ✓ l'
Place of Burial (or Removal).......... . .A-, .
(If body is to be tnporarily held, fill in space later)
Cemetery :---- yzt Date of Burial �f' -1 7 ,<' =� 193./
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful examina-
tion, 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
Numbe , and on the bas'S thereof I HEREBY GRANT A PERMIT
a e) (Address)
the to hold tempora ' y an (---4- ���}}}� the body.
(Undert k r or person having charge of corpse) ter re4herwise disp a of [state how]).
Dated may,/f 19. .7' (Signed Local registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local ceme-
tery 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 19
(interment or cremation)
(Signed)
(Person (26e.W
in charge)
(1(awe 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 c;large," 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 person
whose death occurs in this skate or which shall be 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 dispo-
sition 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 re moval permit shall be issued by any registrar until,
wherever practicable, a complete and satisfactory certificate of death has been filed
with him as heretofore provided; provided that 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 sh 11 be given the same force and effect as the burial
permit herein provided for. go 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 promulkate rules with reference to the removal of bodies of
persons whose deaths occur ott trains, boats or other carriers engaged in the trans-
portation of persons within this;state. (Am'd by L. 1932,ch.267.)
' See section 390.
§ 379. Duties of undert" er. In each case 'thP earfdert .or per-,.on ltav'ng
charge of the corpse, shall file e certificate of death with the .t;gistrar of the district
in which the death occurred an' obtain a burial or removal per.oit prior to any dispo-
sition of the body. * * * 'Die 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 r oval permit to the box containing the corpse, when
shipped by any transportation ompany; said permit to accompany the corpse to its
destination, where if within th 'state of New York,it shall be c elivered to the person
in charge of the place of buria
§ 380. Duties of underta rs; interment within the state. If the interment, or
other disposition of the body i'to be made within the state, the wording of the burial
or removal permit may be lit ited to a statement by the registrar, and over his
signature, that a satisfactory ertificate of death, having ben filed with him, as
required by law, permission is ranted to inter, remove or dispose otherwise of the
body, stating the name, age, s ,cause of death,and other necessary details upon the
form prescribed by the commi Toner of health.
§ 381. Interments. No p son in charge of any premises on which interments
or cremations are made shall ter or permit the internment or other disposition of
any body unless it is acconr `nied 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 signatr, e, and shall return all perm s so endorsed to the
registrar of his district within even days from the date of r t,rment or cremation.
He shall keep a record of all ies interred or otherwise disposed of on the premises
under his charge, in each case stating the name of each de eased person, place of
death, date of burial or disposal, and name and address of the undertaker; which
record shall at all times be opon to official inspection; provit ed that the undertaker
or person having charge of tie corpse, when burying a ody in a Cemetery or
burial ground having no person in charge, shall sign the bu ial or removal permit,
giving the date of burial, and shall write across the face c 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.
t2Er SEXTONS and UNDERTAKERS violating th 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
law will be enforced. ..Local Registrars,are required, under penalty, to report viola-