Gurney, Mary Form VS No. 62. 4-27-43-10.000 (3C-33)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
ISP A Transit Permit and Transit Label issued ky the Local Registrar of Vital Statistics must accompany each
dead body transported by a common carrier—Reg9tilatio:n 1, subdivision 1. <
UNDERTAKER'S CERTIFICATE /
3 Nrrrhy alrrtify that the accompanying dead body of t
who died in the of %�
(City Village or Town)
County of f~ , State of New York,'on. '� 19`S S^�.-. te .•• Widowed' "
Color or race.. / ge ears 6 onths l -days, Birthplace //.`+3' l.'1-, 1" '4,'and Cause
'° Death .. ��L "r^'� �Vhd has been prepared for transportation
m P
f. str ctl i ac ance with Regula on 1, subdivision .as p • ted with this blank. Certificate was signed b
a rc,P.,fin cc" y. o ,
^o -.. , M.D., Address 31. ate of shipment - '`7 - .
3 19 . ; Route of ship ent T "` i1...i ` �e Point of
,, ::eh1t :
.-- 1 4 ; Point of destination ,...-. kt
' "�I
.Co (Signature f Undertaker)
-. 19 Al J Address.... A---------...4. ..it
wpl *Cross out words not applying.
t t. 3 S 1 3 PERMIT OF LOCAL REGISTRAR 3 --
3 Dist. No. egistered No.
4 Date of issuance "� ,).--0 19 S- a
A satisfactory Certificate of Death for above decedent having been filed an recorded in my office, PERMISSION IS
HEREBY GRANTED FOR THE REMOVAL AND SHIPMENT OF,,'H BQDY.
(Signature of Local Regis r) J- W�2`
(A.
Local Registrar of the �` � '� of t+ , County of ,
(City, Village or Town) 1
State of New York.
Only the Local Registrar (Deputy or Subregistrar) may issue a Burial, Removal or Transit Permit
Detach here and give part above to escort or attach to waybill if shipped by express
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE �' `.4.2"
v- /13
- 'rr; t om, moo--c z
Date of " was y w O l
(Interment or Cremation)
(Signed)
v
•Person in charge ofi,�et_ v '^ i x
(Name of Cemetery, Crematoriu , etc.)
Person in charge must return this Permit to Registrar of his District within SEVEN (7) DAYS from above date. If no per-
son is in charge, THE UNDERTAKER 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 FROM VITAL STATISTICS LAW
§ 379. Duties of undertaker. In each case the undertaker, or person having charge of the corpse, shall file the cer-
tificate of death with the registrar of the district 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 disposing 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 he delivered to the person in charge of the place of burial.
§ 380. Duties of undertakers; interment within the state. If the interment, or other disposition of the body is to be
made within the state, the wording of the burial or removal permit may be limited to a statement by the registrar, and
over his signature, that a satisfactory certificate of death, having been filed with him, as required by law, permission is
granted to inter, remove or disnnse otherwise of the body, stating the name, age, sex, cause of death, and other._ne_cessary
details upon the form prescribed by the commissioner of health.
§ 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 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.
FigF 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, to report violations thereof.