Murray, James Form VS.sl., NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
izr 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 WRIT EEN IN DURABLE BLACK INK
Town Registered No....../ 7 0
1A, Village .0 \_ . %R t
Dist. 1�Tb�G o( Co �,`'�. *�- ®r city 3. rG4.� � •.�+
(If city, give street address)
Name of deceased... ... .... ................... Veteran 3
Single, married, widowed, (II veteran, give name ofp War)
'
S Colo or divorced (wrltt the word) Date e e'Z. i 19.-
Age Years.. Monthj�'� �. w. D. s Birpllplac .. r..,
Cause of Death Lr�o �4�-e-S... •
Certificate was signed by l i��/ r M.D.
Address ...
Place of Byr Removal) .d'7NrLt,+ / .(If body is to rail] II I Dace later) yy��
Cemetery Date of Burial /)! #Z,.. 19
(If body is to be temporarily hel fill in space later)
T'hn 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 SATISFAC!'ORY AS REQUIRED BY LAW,
I have a pted the same for registration, have recorded it in my Loc y record °th the above stated Registered
Number and on basis h f I REBY GRANT A PERMIT,, cg.aee
to 771
(Plnar) ddressy . r
the to hold temp. `,t • and the body.
( e er or person P��viag charge of corpse) (Inter, remo/' or othe o f(state howl)
Dated Z- 19..5. .,/ (Signe.A...
Loc.( Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of —..y • y part of the %Rate (was set to local
cemetery 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)ate of 19 ✓r
(lnterme W Lrc.iOio_n
;Signed). ��(� (t��I
(Person
n charge) Qv C
(Name of Cemetery, Cremator etc.)
Person in charge must return this Permit t Registrar of his District within
;EVEN (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
he words "No person in charge," and FILE PERMIT WITHIN THREE (3)
)AYS 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
chose death occurs in this state or which shall be found dead therein shall not be
nterred, 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
jisposition thereof shall have been properly issued by the registrar of vital statistics of
he registration district in which the death occurred or the body was found. No such
)urial or removal permit shall be issued by any registrar until, wherever practicable, a
:omplete and satisfactory certificate of death has been filed with him as heretofore pro-
✓ided; 't * * *,When a (lead body is transported from outside of the state into a
registration district in this state for burial, the transit or removal permit issued in
accordance with the law and health regulations of the place where the death occurred
,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
)errnits under this act other than the compensation provided in this article.* Provided,
however, that the 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
)ther 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
:ha.ge 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 disposition
)f the body. *** The undertaker shall deliver the burial permit to the.person in charge
)f the place of burial, before interring or otherwise disposing of the body; or shall
smell the removal permit to the box containing the corpse, when shipped by any trans-
portation company; said permit to accompany the corpse to its destination, where if
within the state of New York, it shall be delivered to the person in charge of the place
)f burial.
§ 381. Interments. No person in charge of any premises on which interments or
:remations 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 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 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 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
permits are liable to a penalty of NOT 1 FSS THAN FIVE DOLLARS NOR MORE
TUAN FIFTY ram TARS FC1R TI-IF FIRST CIFFFNSF_ The low will be enforced.