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Novarls, William Form vs.AL NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT it 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.—.._...._........... Dist. No.. 04 County...... ... . ..».. or City �• Y, �(if city, glc reef address) Name of deceased )llt. it.ta1.1 ...V. .... .. .. Veteran Single, married, widowed, (If refer give name of War) Sex.... or or divorced (wnte the word).... . . ate of eath V itm‘fLa...19 C. Age. .. 41 Yearph ....M Days ) B" plac .. Cause of Death tit-, .. . .A... Certificate was signed by D. Address 9 . );/\... Place of Burial (or Rem ). .. ...... .... ct 4 (If body is to be temporaril l d fi in space 1 er) 0 , ( — ^' Cemetery ,, t10 Date of Burial �V J 7 19 /!� (If body Is to be temporarily bold,fill in space let r) 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 Noutt16er L the Via f I HEREBY GRANT A PERMIT` 11 .. i . // y dress) the ( to hold temporaril an III���'''"' the body. rek 19.�.... (Signed) t or ,or of tg. o tate h ] (tlnde r rson hating charge o ) ( _,�ll Dated / D ( gn ) l �t�.. Local eglstrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the 'fate (subject to local cemetery or other regulations),unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF .., PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of "�"`^� was_ V C 1 �'� //��1!�9_�__ F_ ....6.10:Atter t or cre lion) Y," -- - �.) - t/U�i-t (Name o emeter Crematorium, e Section Lot No Grave No (Signed) �->..p.3.,,, .W__ (Person in charge) Person in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from above date. If no person is in charge, the LANDER- 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.pf,dead bodig&,. The byre "....t�lit9 c death occurs in this strife 4- t�'h shalt be7 ound dead therein a not be interred, deposited in a vault a tbrnb, cremated or otherwise disposed of or removed from or into any registr ion district, or be temporarily held pending further disposition more than seve ty-two hours after death unless a permit for burial, removal,or other dispositio thereof shall have been properly issued by the registrar of vital statistics of the r istration 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 heictofore provided; * * *. When a dead body is transported from outside of the stpte into a registration district in this state for 'burial, the transit pr removal permit issued in accordance with the law and health regulations of the place there the 'death occurred shall be given the same force and effect as the burial permit herei .provided for. No registrar of vital statistics shall receive any fee for-the issuaT of burial or removal permits under this act other than the compensation provid d in this article. Provided, however, that the 'state commissioner ggf health shall lri ve power to promulgate rules with reference %, to the-removal of be lies of persons., hose deaths occur on trains, boats or other carriers engaged in the transporiatidin of persons within this state. § 379. Duties of undertaker. Ii each case the undertaker, or person having charge of the corpse;shall file the c tificate of death with the registrar of the dis- trict in which the death occurred a 'd.obtain a burial or removal permit prior to any disposition of the body. * * * he undertaker shall deliver the burial permit to the perscrtrin charge of the place f burial, before interring or otherwise dispos- ing of the od • or s is JtacU, ,rempvya er o, hie t, con„ai tt1 °- ♦*iy—Iffy-dal sp ration co Ti any; sat permit to accompa y' 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 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 per- mits 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.