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Laffee, Libby rorm va lvo.ol. J-o-. -Ju,vvu k1/-ou/z) NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT Qom'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 an3 acceptance of a CORRECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Dist. No. J G O / Registered No. 3 -5 County. Village or City (If city, give street address) Name of deceased /Y ........�. .". ... n le, mLriecc i g , �� .Se Colo or divorced (write the word) Date of Death. . 19 3 y ae Years Months Days Birthplace v Cause of Death, .<r/�i- Certificate was signed by ..... .... .. - - M. D. Address . -, I.� T.=Y-' -r Place of Burial (or Removal) ‘,- -e-' (If body is to be to orarily held, fill ' space later) (' Cemetery.... .. Date of Burial / ,/ 7 193 Y (If body is to 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 Number,�/ and the basis thereof I HEREBY GRANT A PERMIT to ' 1 ,a r f 7 ; - ( e) (Address) the..�al to hold temporarily and the body. (Updertake or person having charge of orpse) Int remo a or erwise dispose=of [state how]). Dated � 77 19. .` (Signed) Local Registrar This Permit is sufficient for the Removal (and Interment or Crei�a (ion) 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 pR PERSON IN CHARGE OF PREMISES ON WHIH-I INTERMENTS OR CREMATI q•ARE MADE Date o .... , .... .. 19 (Interment vii cremation) (Signed) (Person )in charge) . (Name of Cemetery*iCrematorium, etc.) Person in charge must return this F' rmit to Registrar of his District within SEVEN (7) DAYS from above date. no person is in charge, the UNDER- TAKER MUST SIGN ABOVE STATE ENT,write across the face of the Permit the words "No person in charge," and I LE PERMIT WITHIN THREE'(3) DAYS with Registrar of District in which' emetery is located. EXTRACTS OF THE VrtfAL STATISTICS LAW § 375. Permits for burial or removal ,f dead bodies. The body of any person whose death occurs in this state or which Ishall be found dead therein shall not be interred, deposited in a vault or tomb, crem&ted 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 Bath unless a permit for burial, removal, or other disposition thereof shall have en properly issued by the registrar of vital statistics of the registration district in`tvhich the death occurred or the body was found. No such burial or removal permi shall be issued by any registrar until, wherever practicable, a complete and satiS, ctory certificate of death has been filed with him as heretofore provided; provided at when a dead body is transported from outside of the state into a registration dis s�ict in this state for burial, the transit or removal permit issued in accordance with t?e law and health regulations of the place where the death occurred shall be given 'Ole 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, hoI ever, that the commissioner of health shall have power to promulgate rules wits reference to the removal of bodies of persons whose deaths occur on trains, bo A or other carriers engaged in *he ti4r,s- plstation.of.ger.sons.w.ithinothia-1Wdiu !i * See section 390. § 379. Duties of undertaker. In each case the undertaker, or person having charge 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 dispo- sition of the body. * * * 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 ter the box containing the corpse, when shipped by any transportation 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. § 380. Duties of undertakers; interment within the state. If the interment, or other disposition of the body is to be made within the state, the wording 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. § 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 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. Q'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 law will be enforced. ..Local Registrars, are required, under penalty, to report viola- ,._..