Silverman, Dora Form vs.U. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Tow]
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE 0
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.-2
Village
Dist. No...........County.......1t...az?-e-id.-- or City
(If city, give street address)
Name of deceased tie477:-.1kw tee..4e---,-*R2...44,- Veteran .-----
(If eteran, give name of War)
L ilL, -7, 'A
Sex.Attcre4.Color../11.1.f.Sir...Single, married, widowed,or divorced (write the word).,r., 17.4reiv Date of D e4th. .4-.14.44- Arl9ds'
Age cf Year40. — Months - Days Birthplace 27
Cause of Death .--n-Z4o,r4r;--e---e `Cce-A---gc?-rfrez?cen--,
Certificate was signed by. 13 eit-r.h. MI
Address „A; . , ,(a.:.,.. , 9
Place of Burial or Removal-) -71‹,--4-r w
xd4 (r.7,414.,.. h. ' , - - -,
(If body is to be te orarily.:27d,li,..tsipace later) /
Cemetery .ar.r4.- Date-^-1.44-el- A.S." 19.C.
(If body is to be temporarily bel ,fill in space later) e of Burial. 9-
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exam:
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAM
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registere
Numbe,rf o the basis thereeioa= RANT A PERMIT
-,--.(/ • • ..:........ h../kkt.. .:71(.44- .... .:..t;
iji..‘74 .4.. ..1e), (Address)
the to hold temporarily d..&44.4-4-- the bod,
/e19..6.72. (Signed) . . ....
(t17 taker or person having charge of corpse)
Dated (I. er,remove,or otb loose of[state bow])
. .olekleu-a-t ...
47.
... . . ........ . .... ..
al Registraz
This ermit is sufficient for the Removal (and Interment or Crernati ) of a body to any part of the (subject to loci
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
I
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
r.:
Date of___ _._t J / t was 19's 4-
(Interment or crematio ).
(Nam�tery,Crematorium, etc.)
Section d� Lot No Grave No
(Signed)- 9AaGati 4144.� - -- ----
(Person in charge)
Person in charge must return this Penrt,t to Registrar of his District within
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
Permit 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
`fir elal•ur .a.a4,val 4,thd•hat;fes. The body of any person
whose death occurs in this state or which shall be found dead therein shall not
be interred, 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 disposition thereof shall have been properly issued by the
registrar of vital statistics of the registration district in which the death occurred
or the body was found. No such burial or removal permit shall be issued by any
registrar until, wherever practicable, a complete and satisfactory certificate of
death has been filed with him as heretoforet'provided; * * *. When a dead body
is transported from outside of the state intoia 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 shall 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 permits under this act
other than the compensation provided in this article. Provided, however, that the
state 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 other
carriers engaged in the transportation of persons 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 to
any disposition of the body. * * * The undertaker shall deliver the burial permit
to the person in charge of the place of burial,before interring or otherwise dispos-
ing,Jac.the bodyi.or shall attach the repioyal_ ntt.tca,tlw.,.-ku erfa* A.=
corpse, when shipped by any transportatiote, mpany; 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 plark of burial.
§ 381. Interments. No person in char c of ally premises on which inter-
ments or cremations are made shall inter or ermit 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 endor a upon the permit, the date of inter-
ment, or cremation over his signature, and s all return all permits so endorsed to
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 on
the premises under his charge, in each case stating the name of each deceased
person, place of death,>;date .glintrial_or d'_ oral, and name and address of the
undertaker; which record`shall at all times open to official inspection; provided
that the undertaker or person having charg of the corpse, when burying a body
in a cemetery or burial,ground having no p rson in charge, shall sign the burial
or removal permit, giving the date of burial, nd shall write across the face of the
permit the words "No person in charge," • d file the burial or removal permit
within three days with the registrar of the dis rict in which the cemetery '-
SEXTONS and UNDERTAKERS violati the law relativ,-
mita are liable to a penalty of NOT LESS AN y"'