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Briggs, Chester Form VS.eL NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT to 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 FLUNG and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No._.. ..47.. Gad Village Dist. No County... . '�?J��- or City GZ — (If city, give street address) Name of deceased Veteran Single, married, wi owed, / ---- (If veteran, give name of War) Sex ' Color.�� or divorced (write the word)74G'�'Yre( Date of eath � :..rl../ 19 / Age V 3 Years Mon ..... .»»...Days Birthplace.... . ,,1.�, - Cause of Death ���G'C'- 7��-tt1 , Certificate was signed by.. ../.3: M.D. Address h�,....11 )j • !�- Place of Burial (or Removal) dl . . 2• Y.- (IL body is to bepporarii held, 11}n spaceya) Cemetery 1�� ��uG , ! �, �4�yti i Date of Burial... ! '. /G 19:r/ (If body is to be temporarily held,fill In space later) Thq 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 to umber rid on be* thereofI,�EREBY GRANT A PERMIT 14 the 7�� to hold tem 'I and the body. (L'nd,t,A t�oUrr,, or person having charge of corpse) (Inter, ,or othe nos f(state how)) Dated 4 ,-C4ree'c e— 9 19.4'J (Signs ...o... Registrar This Permit is sufficient for the Removal (and Interment or Cremation) a y ny part of the subject to local cemetery or other regulations),unless removal 1s by common carrier, in which case Transit Permit (VS No. 62) is required. ENDORSEMENT OF SEXTON OR PERSON IN CHARGE O: PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of was___eela I O 19.0y- _I. 147(I ter nt r c mation) 0Aza (Name of Cemet ry,Crematorium, etc.) Section Lot No. Grave No (Signed) e Go,- _ _ (Pers i in cha e) Person in charge must r urn this Permit to Registrar of his District withi SEVEN (7) DAYS from above date. If no person is in charge, the UNDER TAKER MUST SIGN ABOVE ST.e'sTEMENT, write across the face of th Permit the words "No person in charge," and FILE PERMIT WITHII THREE (3) DAYS with Registrar,cf 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 perso whose death occurs in this state or Which shall be found dead therein shall nc be interred, deposited in a vault'or tomb, cremated or otherwise disposed of o removed from or into any registration district, or be temporarily held pendin. further disposition more than seventy-two hours after death unless a permit fo burial, removal, or other disposition thereof shall have been properly issued by th registrar of vital statistics of the registration district in which the death occurre or the body was found. No such burial or removal permit shall be issued by an. registrar until, wherever practicable, la complete and satisfactory certificate c death has been filed with him as heretofore provided; * * *. When a dead bod is transported from outside of the state into a registration district in this state fo burial, the transit or removal permit issued in accordance with the law and healt regulations of the place where the depth occurred shall be given the same forc and effect as the burial permit herein provided for. No registrar of vital statistic shall receive any fee for the issuance of burial or removal permits under this ac other than the compensation provided in this article. Provided, however, that th state commissioner of health shall have power to promulgate rules with referent to the removal of bodies of persons whose deaths occur on trains, boats or othe carriers engaged in the transportation of persons within this state. § 379. Duties of undertaker. In each case the undertaker, or person havin charge of the corpse, shall file the certificate of death with the registrar of the dis trict in which the death occurred and obtain a burial or removal permit prior t any disposition of the body. * * * The undertaker shall deliver the burial permi to the person in charge of the place of burial, before interring or otherwise dispos ing of the body; or shall attach the removal permit to the box containing th corpse, when shipped by any transportation company; said permit to accompan. the corpse to its destination, where if within the state of New York, it shall b delivered to the person in charge of the place of burial. § 381. Interments. No person in charge of any premises on which inter ments or cremations are made shall inter or permit the interment or other dispo sition 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 inter ment, or cremation over his signature, and shall return all permits so endorsed t, the registrar of his district within seven days from the date of interment or cre mation. He shall keep a record of all bodies interred or otherwise disposed of of the premises under his charge, in each case stating the name of each decease, person, place of death, date of burial or disposal, and name and address of th undertaker; which record shall at all tiknes be open to official inspection; provide, that the undertaker or person having etiarge of the corpse, when burying a bod: 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 th. permit the words "No person in charge," and file the burial or removal permi 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 MORI THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced