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Bardin, Gary Form vs.Si. NEW YORK STATE DEPARTMENT OF HEALTH . i OFFICIAL BURIAL (OR REMOVAL) PERMIT MA , - sir This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration II trict (Town, Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CER IFICATE OF DEATH, LEGIBLY WRITTEN IIr DURABLE BLACK INK. Town Registered No.._.,3..1 i Dist. No, County..._...�/l»..>E -r'"A e-lk- Village or City .� •� � (If city,give street address) Name of deceased 1fe-7 Veteran -----` ,,,, /f Sg , married, widowed, . Q (If veteran. give name of War) Sex..)441. ,Color..` % or divorced (write the word)... 14. Date of D ath ..,/ 3//3'',,.�� 195.. Age Y Months ...2.. ..says Birthplace... .. ��� r.v.a,•. ;:ause of Death .. . Elir Certificate was signed bye..,.. Q..,,.,, M.D. Address �� .. . . ;14-q. Place of Burial or Removal)... .�C... ... .. . rV, j,,.,,.,Y ;If body Is to be to pore y held, In space 1 / / Cemetery.....‘‘. . .... Date of Burial / O /4?" 19.4... ;If body Is to be tempora held,1111 In space later) nin Certificate of Death containing the above stated particulars, having been presented to me, after careful exami- iation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have ac pted the same for registration, have recorded it in my Local Record with the above stated Registered dumber on the basis tc.,„. .),/,y., \ f ME Y.GR ERANT A PERMIT /e he r:1R.. .G .. . to hold to por and (Address).... ..., the body. (Unde er or person h ng charge of corpse) (Inter,r.•.`ve, • ot. �no of state how]) )ated ,/ i g. 19...1.13 (Signed) r' • ''i�""""' • al R This Permit is sufficient for the Removal (and Interment er Cr Mien) of body to a y pert • the State (subject to local .matery or other regulations),unless removal is by common ea'kw, n which cas a Transit 'ermit (VS No. 62) is required. y,M yY_' PREMISES ON WHICH_INTERMENTS OR ~�vy v_ CREMATIONS ARE MADEI (y ,/ Date of_ was___V__S 0 ii .j 19d ,3 (lute cent or ematio • Mr" ame of Cemetery,Crematorium, etc.) Section r Lot No. Grave No (Signed)__ _ __�_ _ ( on in charge) Perso n charge must re is Permit to Registrar of his District within SEVEN 7) DAYS from abov ate. 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 § 375. Permits for burial or removal of dead bodies. The body of any person whose death occurs in this state or which shall he 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 heretofore provided; * * *. When a dead body is transported from outside of the state into a 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 of the body; or shall attach the removal permit to the box containing the corpse, when shipped by any transportation 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 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 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 of burial or disposal, and name and address of the undertaker; which record shall at all times be open to official inspection; provided +hat the undertaker or person having charge of the corpse, when burying a body ka cemetery or burial ground having no person in charge, shall sign the burial -*ioval permit, giving the date of burial, and shall write across the face of the the words "No person in charge," and file the burial or removal permit -e days with the registrar of the district in which the cemetery is located. and UNDERTAKERS violating the law relative to the return of per- to a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE Y DOLLARS FOR THE FIRST OFFENSE.The law will be enforced. etrars, are required. under penalty. to renort violations thereof.