Daniels, Wyatt Earn V 0 010.01. J-V-OJ-Jv,Vw !1/-JV/G)
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
lar 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.c6 957 Registered No
/ Town, C
County '(-A) Qt.LA.E--'-<-- Village
or City (If city, give str address)
Name of deceased.... . ... . C. i✓
Single, married, widowed, •
Sex t �cColor.. .... . or divorced (write the word) LJ,(d � -r€_.J Date of ath 190, 1
Age 6.6 Years Month . /3 Da s Birthplace '
�.� ..
Cause of Death...... ... . .... .. .. ... ..... . ....
Certificate was signed b ", - .._- M. D.
Addressi� L�l x//iz�` .:.
Place of Burial (or Removal)....ha -Y�� -Fier
(If body is to b 1 po arily/5 , fill in space later) i
Cemetery /1 W .. .... Date of Bu al.... .. 9 19�
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated pa i ulars, having been presence 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
Numb r, and_on the basis eof I HEREBY GRANT A PERMIT y/
to .L4W ��Qx&-,y 71 y
cc Ta Q (Address)
the..S 1 �-0 to hold temporaril and CJ� / t •' body.
ndertaker r p son having charge of corpse) Int , remove or of Ise d'le of [state how]
Dated , (e 19.3. (Signed)...... . . .. .. ..... .. .. .... A ,gr 0, '.
Local Registrar
This ermit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local r-me-
tery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No.62) is required.
ENDORSEMENT OF SEXTON -TOR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
_ CREMATION1 ARE MADE
Date of (,,.!,;<,:'. t� 19.1�..
` (�( „(Interment o cremation)
(Signed) CF L:..440- tissN
(Person � �"r
in charge) 7/'
Name of Cemeter' Crem orium, etc.)
Person in charge must return this rmit to Registrar 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 chargP," and LE PERMIT WITHIN THREE (3)
DAYS with Registrar of District in whic cemetery is located.
EXTRACTS OF THE V AL STATISTICS LAW
§ 375. Permits for burial or remova a'of dead bodies. The body of any person
whose death occurs in this state or whic, shall be found dead therein shall not be
interred, deposited in a vault or tomb, cre`.ated or otherwise disposed of or removed
from or into any registration district, or • 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"Peen properly issued by the registrar of
vital statistics of the registration district i s which the death occurred or the body was
found. No such burial or removal pen it shall be issued by any registrar until,
wherever practicable, a complete and sat"',factory certificate of death has been filed
with him as heretofore provided; provide i;that when a dead body is transported from
outside of the state into a registration d'a.trict in this state for burial, the transit or
removal permit issued in accordance wit the law and health regulations of the place
where the death occurred shall be give the same force and effect as the burial
permit herein provided for. No registra 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, lwever, that the commissioner of health
+hall Ma+uq{atawerr+ 1L>.li ‘ii,k .• ith reference to the removal of bodies of
persons whose'deaths"oecuror. vratns,` is or other-c:.rriera engaged in the trans-
portation of persons within this state. (Ailti'd by L. 1932,ch. 267.)
* See section 390.
§ 379. Duties of undertaker. In e4ch 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 to 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 I\ew 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} laurial, cremation or transit permit, as
herein provided. Such person shall enddrse 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 pante and address of the undertaker; which
record shall at all times be open to offipial inspection; provided that the undertaker
or person having charge of the corpso� when burying a body in a cemetery or
burial ground having no person in charg�e, shall sign the burial or removal permit,
giving the date of burial, and shall w lte across the face of the permit the words
"No person in charge," and file the bu 1 or removal permit within three days with
the registrar of the district in which th cemetery is located.
I'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 Registrar:are required, under penalty, to report viola-
tions thereof.