Cohen, Henry Forst as.SI. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr 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 A D COMPLETE CERTIFE OF
DEATH, LEGIBLY WRITTEN IN DU LE BLACK INK. Town / R " teredy /........ _ ._._
Dist. Wo....._ . , County. ... .. . /Village ir
e, , or City 3c .0.24 .4//
(if city,give street address)
game of decea d. . .("),,, / , Veteran
/72 Singles oo,rd i 1/ 0 Date .0 name of Var
0,
eig .. ?earsMonths.....(*wn, tweidoviwed
. v a A iwi a c.I f..,.4
1... /
,.'
rthplOce. -.441-0 ..0,/ .....
:ause of Dea Apr. 0#110.--1
certificate was signed by . . ...- AO......,,.. ......./.7/ M.D.
Address. ... L . 4.-;:"" _...... „.... ..,
N.77,4.5.-.. - ,.. ...r ... ,‘"Vo, ,
?lace of Buiial (or • ;f5:;5c:... . .
If body is t- be temp. -,rifi -Id,all ••••ty‘clue.alote---- a ...„„-01.- -- , ti.t. ,
Cemetery... .. -4.°V.e2e22..-..... . Date of BurialogV ' GP 19.5./
If body Is tobe tem..rarily held,all in space la )
rhet Certificate of Death containing e above stated particulars, having been presented to me, after careful exami-
iation, the ame appearing to be COMPLETE, CORRECT, AND ATISFACTORY AS..REQUIRED :Y LAW,
have m.14 e same for ' tion, t4 ve r- ' .,./ it y o Record with t4above sta 1:1ste
in.. • -• ,, • • II basis . '1' E•i: :Y ra7)., I
:/z
/ jfr
. .v/e
— 4:ril!, . ..
Ad rue).4!: 71"44r" / / (
old tern ' nd the body.
(V•• rir-e•r affix ehargepse-eolpse) de (Inter, ,or otbe ,o (state howl)
)ated'....ele I9, (Signed .(..
Loe Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) a any part of • subject to local
smelters or other reenlations).unless removal is hip eeme.,,,......4e. :... ...A:As ..... . T....4 1,......lo fiIR 111... 091 :. .........:......1
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of U""e/IL 19 -) ,!
(Into�,nt or-•remation
(Signed) L..4.-t' :_C .�
(Person
in charge) .._ . .. _.
(Name of Cemetery, Cremator' ,etc.)
Perso n charge must return this Permit t Registrar of his District withii
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. Permits for burial or removal of dead bodies. The body of any verso'
whose death occurs in this state or .. ic1, shall be found dead therein shall not 1N
interred, deposited in a vault or tomb, cremated or otherwise disposed of or remove(
from or into any registration district,or be temporarily held pending further dispositioi
more than seventy-two hours after death unless a permit for burial, removal, or othe
disposition thereof shall have been properly issued by the registrar of vital statistics o,
the registration district in which the death occurred or the body was found. No suet
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 pro.
vided; * * * *.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 it
accordance with the law and health regulations of the place where the death occurrec
shall be given the same force and effect as the burial permit herein provided for. Nc
registrar of vital statistics shall receive any fee for the issuance of burial .r remova
permits under this act other than the compensation provided in this article.* Provided
however, that the commissioner of health shall have power to promulgate rules wit}
reference to the removal of bodies of persons whose deaths occur on trains, boats of
other carriers engaged in the transportation of persons within this state.
•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 it
which the death occurred and obtain a burial or removal permit prior to any dispositior
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.reinaval.oermit to_the Wet vetainipg the corpse, when shipped by any trans•
portation company; said permit to accompany the corpse to its destination, where ii
within the state of New York, it shall be delivered to the person in charge of the plac,.
of burial.
§381. Interments. No person in charge of any premises on which interments of
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 ave. hi:
signature,and shall return all permits so endorsed to the registrar of his district withir
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 buria,
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 withir
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 I FSS 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 violations thereof.