Lashway, Genevieve _Form vs.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
to This Permit can be signed only by the Local Registrar (Deputy or 4ubregistrar) 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 Registered No 3 a/
Dist. No .1' fL.Coup Village ����A,,
G = ty....,�a'l�?`d>'it/ or City .. `:�� �- 3.
4 •
(If city, give Street address)
Name of deceased, / . .. Veteran
Single, married, widowed, (lI vet, n. give name of War)
Sex.. . . . . Color... ... :. ....or divorced (write the word) Date of Death. - 19 /
Age *4' ' Years // onth G s � Days Birthplace... . i. .. . .
Cause of Death , ...
Certificate was_signed by ar '-c G� M.D.
Address ., a- ,-+ 7j; V.
Place of Burial (or Removal) --- ...C��f.4�R •t ..,t... /.....,
(If body is to be to J.�rf ly held,fill in space late
Cemetery .� .. . Date of Burial .. • '�• 194./
(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
Numher, d oonn the� basis t of I HEREBY GRANT A PERMIT 7GG
toiQj' aK...l .e ✓....
(sedrems
the to hold to • and.. .-- the body.
(U de er oa bavin charge of corpse) (Inter, ,,o, ,or otherwise dim os of ho I)
Dated ... . �` f
....19...../.. (Sign�d .�... ..,.,.
Kist1ar _ _.
This Permit is sufficient for the Removal (and Interment or Cremation) of y to a part of the Mae to local
cemetery or other regulations),unless removal is by common carrier, in which case k Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE 0]
PREMISES ON WHICH INTERMENTS OR
CREMATIONSf ARE MAD
sr_f' was 6 1941-)
- nteLment or )
(Name of Cemetery,Cpteniatoritim, e A /—+�
Section_____ ___ __! �� Lot vNoo.-_ Grave No._I
(Signed)tpVeg , ;, if1if1 -tti a
(Person in charge)
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 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 no
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 pendin1
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 o
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 healti
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 referenc
to the removal of bodies of persons whose deaths occur on trail s, boats or othe
carriePetngaged in the transportation of person's within this state.
§ 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 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; provide(
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
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