Frasier, Iva Form v8.sL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
tr 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 IN DURABLE BLACK INK. Town o.__..
.......�.( /..i �..z o VillageCiy SA BAT A I!TON. Y,
Dist. No- . 0 County.. .
(If efty,give street address)
Name of deceased ���-'��-e-/ Veteran
Single, ma ed, widowed, (If veteran, give name of War)
Sex T ,olor or divorced (write thlee,word) Date of each 4"1- , 3 9 `ri
Age ht.ir Years.. •Months.......,:ri .1.»... ays Birthplace.1��' ),, , ,
Cause of Death
Certificate was signed by - , .l M.D.
Address G7� �............. .....��
Place of Burial (or Removal)... +-
(If body is to be to rarity I i space later)/6� / // ` ' /
Cemetery ,.�
Date of Burial �-17' • 4 19fa$T1
(If body is to be temporarily hel 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
Noumberr apd olp-the basis thereerI HEREBY GRANT A PERMIT
)
the xa to hold temporarily and ..+7`4 v .., �i t, body.
(IInd key�r pen having charge of corpse) (I e , move,or otbe sno estate •ow,,,,
Dated i"r'I 19 r7 (Signed) !I h. �%
al A . , ��*'
This Permit is sufficient for the Removal (and Interment or Cremation) of a body any part of the
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) ; •`y
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE O:
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MA Eti
Date of c was • 6 19_ L
(Interment .
(Name of C eter ,Cre orium, etc.)
Section__ ./j, "`t_ _ of No 2,E____Grave No Z..
(Signed)Person in charge must return61t81,21n•itilWALA•4:44.0‹,..
to Registrar of his District withi
SEVEN (7) DAYS from above date. If no person is in charge, the UNDER
TAKER MUST SIGN ABOVE STATEMENT, write across the face of th
Permit the words "No person in charge," and FILE PERMIT WITHII
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 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, a 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 death 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 times be open to official inspection; provided
that the undertaker or person having charge 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
nits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORI
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. 'Tha law will ha wnfnrrwi