Borlowsky, Bessie 7ortra vs.dL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar 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
L)ATILEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.._.44 :..7
.S Village
Dist. No:.. .�/ County.....�� or City �
774- ,,"2-'
(If city,give street address)
Name of deceased Veteran
A, Single, married, widowed, (if veteran, sine,name of War)
Sex.-r --<olor rG`-or divorced (write the word) .. ed Date of D t1111- 19
Age A- Years v Months .1. ..Days Birthplace ��
Cause of Death .
Certificate was signed by x....4i. M.D.
Address ----'i -)j:,
Place of Burial (or Removal) 1 ,
(If body is to be temporarily held,fill In awe later)
Cemetery -4:£ Date of Burial 19
(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 exami-
nation, 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 on the basisihereof I HEREBY GRANT A PERMIT
to - '--.-- , 7(4 �� =��:.ae' ) . te./
(Name) �� (Address)
the '" to hold tempora and the body.
(Undertaker or person having charge of corpse) , (Inter, remove,or otheral (Monona of[state how])
Dated 6.:k.a,... ., .:C... ..s4.:..19...c.e.'.. (Signed).. .
Local Registrar
Thisl'ermit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
:emetory 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 W 1s' 4 4 was 19 St"./
(Inter o c ation)
• ame of Cemetery,Crematorium, etc.)
Section Lot No Grave No
(Signed)
Odkaftil.......
on in charge)
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. Permits for 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
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 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 provided; * * *. 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 ' c duce with the 1a ,ti,gjt
regulations of tile place where the`� C s hall be given the 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, however, that the
state commissioner of health shall have power to promulgate rules with reference
to the removal of bodies of persons whose deaths occur on trains. boats or other
carriers engaged in the transportation of persons within this state.
§ 379. Duties of undertaker. 1 n each case the undertaker, or person having
charge of the corpse, shall file the certificate of death with the registrar of the dis-
trict in which the death occurred ansi.,obtain a burial or removal permit prior to
any disposition of the body. * * *_T undertaker shall deliver the burial permit
to the person in charge of the-pl3eeeo burial, before interring or otherwise dispos-
ing of the.body; or shall--atlas . .4.4414,,pertt!it -to the boa.,sstttoining.the
corpse, when shipped by any transp rtation company; said permit to accompany
the corpse to its destination, where within the state of New York, it shall be
delivered to the person in charge of e place of burial.
§ 381. Interments. No person in charge of any premises on which inter-
ments or cremations are made shall ' ter or permit the interment or other dispo-
sition of any body unless it is accom icd by a burial,cremation or transit permit,
as herein provided. Such person sha endorse upon the permit, the date of inter-
ment, or cremation over his signature,, and shall return all permits so endorsed to
the registrar of his district.within set,*.tl s to i,the date of interment or cre-
mation. He shall . botlf "»1 'Otherwise disposed of on
e.„,pine it er is charge, in each case stating the name of each deceased
rson, 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.
SEXTONS and UNDERTAKERS violating the law relative to the return of per-
mits 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.