Knickerbocker, Deborah Form vs.al. NEW YORK STATE DEPARTMENT OF HEALTH 7, 4?.,5
*y
OFFICIAL. BURIAL (OR REMOVAL) PERMIT /
fr This Permit can be signed only by the Local Registrar (Deputy or subregiatrar) 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.__.._ ...4...
Village._. . _ y
Dist. No County... r Ci
(If city, give str, a
Name of deceasedVeteran ��_4s��
4.41,7_s
]IIgle, married, widow , •
(If teran give name}of War)
f - r divorced (wnte the wordy—�'` Da f Dc `I . �f. .. l i
Age `"—'Years the .? ..D Bi -
Cause of Death •
Certificate was signed b .. .. ...l�� . .... M.D.
$?
Address .. f,., ,! `. .o'.. -
Place of Bu d1 (or m.v`al >" _ •• �, � ••
(If body le to poea y h e� i p e
Cemetery
� :�•'r-' Date of Burial cr 19 /
(If body is to be temporarily held,fill in space later)
The Certificate of Death containing the above stated particulars, having been pr.wtited to e, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, ve recorded it in my Local Record with the a e ted R gistered
Num on the s' eof I HE BY GRANT A PERMIT '
P (N. !0,1� d
the .. ..... . . .,.....A-me................to hold temporafily a . .. ..the bo y.
(Un -rtak or a h charge-ot orpee) ( r, remove or otherwige linos of[state owl
Dated 191.i (Signeilj f - . / . .
Local A
This,- is sufficient for the Removal (and Interment or Cremation) of a body to any part of th oval
cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS .
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE O:
PREMISES ON WHICH INTERMENTS OR
EMAT NS ARE MADE
l
Date of___ was 1J_19 ___G
(Name of emetery, r atorium,
Section-__ __ _ Lot No.__`_J/____Grave No
(Signed)---- �= 9-#41�
Person in charge)1
Person in charge must return this Permit to Registrar of his District withi
SEVEN (7) DAYS from above date. If no person is in charge, the UNDEF
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 nc
be interred, deposited in a vault or tomb, cremated or otherwise disposed of c
removed from or into any registration district, or be temporarily held pendin
further disposition more than seventy-two hours after death unless a permit fc
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 c
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 fc
burial, the transit or removal permit issued in accordance with the law and healt
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 a(
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 trains, boats or othe
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 t
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 dispo5
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 arc made shall inter or permit the interment or other dispc
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
anent, 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 cr(
mation. He shall keep a record of all bodies interred or otherwise disposed of o
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 burib
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 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 enforcec