Jenkins, Edward Vora VS.a. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
Sr TYs 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 Re 'stored No.__.-- -'. .—_..._
/ Village
Dist. No.: .1...Coon _..... ...
ty... or City
� � � / (If city, give street address)
Name of deceased G;..atsti:-r. t Veteran
/ Single, mar ed, owed, (If veteran. give name of War)
Sex/.. .-. Color.U° :Grp..- z...or divorced (write the word)..�,1r W
Date of D�ea- ... .G 19.S 4—
Age �" Years � Months 1�.....pax Birthplace II` ,/ '
Cause of Death 7, ..a
Certificate was signed d b ,_-�- -- /� �y , — --- M.17
Address
Place of Burial (or Removal)
(If body is to be temporarily held,fill in space er) I, �
Cemetery ,p, b ,,,,, Date of Burial 2" i 19.S2"'
(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
Number, and on the basis thereof I- HEREBY GRANT A PERMIT
to l�"4 -..,��— iV LC. -_ 3 (( f ,S�—
(I�Iame) rest)
the -:C.-:k:: ..f to hold temporarily and t.1 ..the body.
(Undertaker or person havingcharge of corpse) (Inter,remove,or oche se dispose of[state how])
Dated , ki 4#,�...a Y 19...$( (Signed)
JLocal R
This Permit'is sufficient for the Removal (and Interment or Cremation) of a body to any part of e State (subject to local
cemetery or other. prig),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required.
IDORSEMENT OF SEXTON OR PERSON IN CHARGE 0
PREMISES ON WIICH INTERMENTS OR
CREMATIQNS ARE M E ,cam
me rment
te,..44f1`er- (Name of Cemetery, -rematorium, etc.,)
Section-__ LotNd ?2 Grave No.-_ _ -
(Signed) .�JGJw-�l2-- 4 -..1 i,2af
(P n in charge)
Person in charge must return this Permit to Registrar of his District wit
SEVEN (7) DAYS from above date. If no person is in charge, the UNDE
TAKER MUST SIGN ABOVE STATEMENT, write across the face of
Permit the words "No person in charge," and FILE PERMIT WITHI
THREE (3) DAYS with Registrar f District in which cemetery is located.
EXTRACTS OF THE I VITAL STATISTICS LAW
§ 375. Permits for burial or r val of dead bodies. The body of any persc
whose death occurs in this state ' which shall be found dead therein shall nm
be interred, deposited in a vault omb, cremated or otherwise disposed of c
removed from or into any registra ibn district, or be temporarily held pendir
further disposition more than seventy-two hours after death unless a permit f(
burial, removal, or other disposition thereof shall have been properly issued by tl
registrar of vital statistics of the registration district in which the death occurr(
or the body was found. No such burial or removal permit shall be issued by ar
registrar until, wherever practicable, a complete and satisfactory certificate ,
death has been filed with him as heretofore provided; * * *. When'a dead boc
is transported from outside of the state into a registration district in this state f(
burial, the transit or removal permit issued in accordance with the law and heal`
regulations of the place where the death occurred shall be given the same for(
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 a,
other than the compensation provided in this article. Provided, however, that U
state commissioner of health shall have power to promulgate rules with referem
to the removal of bodies of persons whose deaths occur on trains, boats or•oth(
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 di
trict in which the death occurred and obtain a burial or removal permit prior I
any disposition of the body. * * * The undertaker shall deliver the burial perm
to the person in charge of the place of burial, before interring or otherwise dispo;
ing of the body; or shall attach the removal permit to the box containing U
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 I
delivered to the person in charge of the place of burial.
§ 381. Interments. No person i charge of any premises on which inter
ments or cremations are made shall liter or permit the interment or other lisp(
sition of any body unless it is accompanied by a burial, cremation or transit permi
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 se n days from the date of interment or cr(
mation. He shall keep a record of all bodies interred or otherwise disposed of o
the premises under his charge, in ea•h case stating the name of each decease
person, place of death, date of buria, or disposal, and name and address of th
undertaker; which record shall at all t!mes 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 burls
or removal permit, giving the date of burial, and shall write across the face of th
permit the words "No person in chatge," and file the burial or removal perm
within three days with the registrar of;the district in which the cemetery is locate(
SEXTONS and UNDERTAKERS violating the law relative to the return of pei
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 enforce(