Normandin, Delia V01111 vs.si. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gar 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
DEATH, LEGIBLY WRITTEN I D -• •LE BLACK INK. Town gist-, , i o45)1....S.............._
Dist. N4 /Countyi A ad4/4,-.7-_ Village .fem7 . ,/ ,‘
or City
ero (If city,give street address)
game of deceased... . , , 0 ...... .., 01,291,24,1/401. Veteran
7), fAl Sinfe, married, widowed, 6
3 . . AAA., .. ;.7 ....or ivorced (wnte the word .. . d
(4
;F Date jeath4 ran. give /name of Wall....
• 0 1960./
kge Years Agr. . Rth,...,/ • s .J.. .,,'"r ys rah ac
2ause ofge t7h JP" - , `-' ...• di , '' x
,..,
IF'C 4d, •ertificate was si., ,". 6r,.
v ( ., M.D.
14dep .ar
Address..... ...014F ,/,.-
)lace of Butial (or . i% •va , ,.., .. .<.• - ....0" ''' ,.0' /
If body le V be te-por r/ Date of B Id,J./. ' ;1. r)
1
Al' .13.196)
''''' 6, - al.
If body Is to'be te", ." ly held,fill ,I pare iii r
rha Certificate of Death con aining the above stated particulars, having been pr cited to m fter careful exami-
ration, the same appearing to be COMPLETE, CORRECT, AND SATISFAC.-ORY ASJ4 QUIRED BY LAW,
have accept e seine for re *strat'o. have r rded it,,.• my o ecor with ve staMisirili
iumber, is th I '%' Y I. „Ty O
CS .07 4r" /.. all
. . .... ...
..1 /
he 44601}., . forlititalr° '' to hold te and the body.
I 7"'" or person patsy champs(°prime) (Inter ye,or otbe (state bowl)
)atect4igee-" • ..K .0'. 19 „( (Si -
al It
•r• ermit is sufficient for the Removal (and Interment or Cremation) of y o any ;sit of the (eubject to local
em or other resmlations).unless removal is by common carrier_ in which cAmat a Transit Pr. ,* (VS Nn_ a 21 fe Peff11;11411114-
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MAD Data of c�. ............� >
(Interment or cremation) �< r"`4 x,rQ
(Signed) --- i
(Person /or
in charge) ;
(Name of Cemetery, Cremator' m, etc.)
Person in charge must return this Permit to 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 Fermi
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 persoi
whose death occurs in this state or which shall be found dead therein shall not b
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.
,,:cposition thereof shall have been properly issued by the registrar of vital statistics o
the -egistration district in which the death occurred or the body was found. No sucl
burl ,r 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 -strict in this state for burial, the transit or removal permit issued it
accordance wii. •he law and health regulations of the place where the death occurree
shall be given th, ame force and effect as the burial permit herein provided for Nc
registrar of vital s. ''sties shall receive any fee for the issuance of burial .;r remova
permits under this act her than the compensation provided in this article.* Provided
however, that the comn..•sioner of health shall have power to promulgate rules wit)
reference to the removal c," bodies of persons whose deaths occur on trains, boats of
other carriers engaged in th, 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 removal permit to the box containing the,..orpsc, when shipped by any trans
portation 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 the place
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 ore hit
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 wtthir
three days with the registrar of (he 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 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 violations thereof.