Demarest, Josephine Form vs.aL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
fr This Permit eau be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) i(y.which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Tdwii Registered No._...
i-kDist. NoO� Village-
(1 Ity, give street address)
,
Name of decease .. teran
Single, married, widowed, / 1 (;If veteran, give name r war)
Sex.... .!. :..Color ,vor divorced (wnt a word ... Date o a �.
Age `Y r •Months.. ..6..... »...Days Birthplace. .. . n.!....
Cause of Death. ...4.
Certificate was signedpby. , ... . M.D.
Addis. ..L .
4-1Wirfl.
Place of Buri r Remov i 7.
(If body is to b grittily held its space later)
Cemetery.... .a. c.,-r �L.$„f.�f.!`l Date of Burial... ../ 41 j
19 5'
(If body is to be temporarily held,All in space later)
Th4 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 hair a ted the same for registration, have recorded it in my Local Re rd with..the..ahgve stated Registered
Nu> and `on,+ basil' h f HEREBY RANT A PERMIT,�y
to..... ... . . . ....... ,( t !;...1�� ��-/( l /7' ,^®���.
(Name) (Address) r/
the y to hold temporaril an the body.
( ndertalier o� non ,fig charge ,.corpse) (Inter,remove,or o se disrose is how ) y
a' / ;1 19..I,.l... (Signed)i . . .. ..
.Local Registrar
- e--- the Removal (and Interment oe Cremation) of a y to any part of the State (subject to local
—+ova/is by common carrier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE (
PREMISES ON WHICH INTERMENTS OR
rl,, CRE�MA/TION ARE MADE
Date of .,��Tl 1 2..ls-'- ^ " '— L. Co 19
(Inte r n)
(Signed). . . �7*,J ..._Y...`-.��'�� �• �
(Person I�uL(R a•••••• h Z! (%l
in charge ,f...
(Name of Cemetery, Crematorium, etc.
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 the Pert
the words "No person in charge," and FILE PERMIT WITHIN THREE (
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 pers
whose death occurs in this state or which shall be found dead therein shall not
interred, deposited in a vault or tomb, cremated or otherwise disposed of or remov
from or into any registration district,or be temporarily held pending further dispositi
more than seventy-two hours after death unless a permit for burial, removal, or oth
disposition thereof shall have been properly issued by the registrar of vital statistics
the registration district in which the death occurred or the body was found. No sui
burial or removal permit shall be issued by any registrar until, wherever practicable,
complete and satisfactory certificate of death has been filed with him as heretofore pr
vided; 'f * # *.When a dead body is transported from outside of the state into
registration district in this state for burial, the transit or removal permit issued i
accordance with the law and health regulations of the place where the death occurre
shall be given the same force and effect as the burial permit herein provided for. N
registrar of vital statistics shall receive any fee for the issuance of burial or removz
permits under this act other than the compensation provided in this article.* Provide(
however, that the commissioner of healthishall have power to promulgate rules wit
reference to the removal of bodies of persons whose deaths occur on trains, boats o
other carriers engaged in the transportation of persons within this state.
•See section 390.
§ 379. Duties of undertaker. In ach case the undertaker, or person havinf
charge of the corpse,shall file the certificate of death with the registrar of the district it
which the death occurred and obtain a burial or removal permit prior to any diepositiot
of the body. • ** The undertaker shall delver the burial permit to the.person in charge
of the place of burial, before interring oil otherwise disposing of the body; or shall
attach the removal permit to the box contalmng 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
of burial.
§ 381. Interments. No person in charge of any premises on which interments or
cremations 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 LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced.
Local Registrars, are required, under penalty_ t.. -'-- _t_t -. -