Titus, J Seward Form VB.iL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
gr This 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 Registered No._./.4..`.f......_
Oneida Village Marcy
Dist. No.3..� f.....County e or City
(' (If city,give street address)
Name of deceased ,few('� o f f f f v.,r Veteran ,et-o
(IE veteran, give name of War)
Single, married, widowed,
Sex !t'`^ b Color (At' or divorced (wnte the word) 4'`'8'6`' Date of Death ' i 19 're.
,J Years I Months sr,,..........Days Birthplace (7(ek,I- -1Q e e 4 Al S7
Cause of Death i villa r / ,L. ct...o : a CO Co 1.,
Certificate was signed by c C'-) ✓ M.D.
Address
Place of Burial (or Removal) "ie.Tl2 T'a1.l5., l'', VIA
(If body is to be temporarily held,fill in space later) 1 —1
Cemetery ^line-T T•?,nQ fQ,,- ter--a nr.nf ucens^urDate of Burial LT n-le.....,,, 19
(If body is to be temporarily held,fill in space Iater)
Tht 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 )Q17.4` .Tr.' ...T., PPt"t r 1 j:_ ?"Ten ').b. , --lens n2:1_1_s,7% .,.
(Name) (Address)
the Tom;-iex:talzer to hold temporarily and...:'. '.£.'.I' the body.
(Undertaker or person having charge of corpse) (Inter,remove,or othe dispose of(state how])
Dated --- q].., 19....514 (Signed) c -�
....... ... .. .. ..... .. .
De a egt.trar
This Permit is sufficient for the Removal (and Interment or Cremation) of a y to any part of the State (subject to local
_.._.-a..� ..L.... ..�,....i_e......\ sews Loa.riw.i.rv,Y if Rv nn.s,e••..n ianrrier_ :n v.l.irl, rasa a Trenait Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF
PREMISES ON WHICH INTERMENTS OR
CREMATIONS ARE MADE
Date of �f le{yj1i 19 O 7
(Interco gr cremation)
(Signed) .515.rztif /T4414
(Person
in charge) ..y14.4 y 4
(Name ot'Cemetery, .rematorium, ere.)
Person in charge must return this Permit to Registrar of his District withit
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 Permi.
the words "No person in charge," art] 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 persoi
whose death occurs in this state or which shall be found dead therein shall not b
interred, deposited in a vault or tomb, cremated or otherwise disposed of or removes
from or into any registration district,or be temporarily held pending further dispositiot
more than seventy-two hours after death unless a permit for burial, removal, or othe,
disposition thereof shall have been properly issued by the registrar of vital statistics o
the registration district in which the death occurred or the body was found. No suc)
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 pro
vided; * * * *.When a dead body is transported from outside of the state info
registration district in this state for burial, the transit or removal permit issued it
accordance with the law and health regulations of the place where the death occurrec
ilia!! be given the saute force and effect as the burial permit herein provided for. Nc
registrar of vithl statistics shall receiy. any fee for the issuance of burial or remova
'ermits under this act other than the compensation provided in this article.* Provided
however, that the commissioner of health shall 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 each case the undertaker, or person having
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 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 disposing of the body; or shall
attach the removal permit to the box containing the corpse, when shipped by any trans
portation company'; said permit to accompany the corpse to its destination, where ii
within the state of New York, it shall be delivered to the person in charge of the plact
of burial.
§381. Interments. No person in charge of any premises on which interments of
cremations are made shall inter or permit the interment or other disposition of any hod,
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 Dyer hit
signature, and shall return all permits so endorsed to the registrar of his district withir
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 buria
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 withir
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.
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