Gourdey, Norman Fcru, VS.4L NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
ar This Permit WA ha signed only by tit* 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-24.2....-
Dist. No 5-40/ County. Village-...22. 47.2z.....
/ (II city, give street address)
Name of deceased 1/ Veteran ---Z-z Single, married, widowed, --
(ff veterau. give name of War)
in ijr___,
Sex 2)2 at- Color..a7L ..or divorced (wnte the word)..11.<.../...1(Lifel Date of Death .„./.(..j:,..4,-c.,........1.7......19..zy
d Age 9 Ye rs ‘) Mon s......:=.'..,....--...Days ,--D
Cause of Death........ ...
Certificate was signed by.., - ... -- M D.
Address .iVie C-5,-/-t.-1 ); ? .
Place of Burial (or Removal) 7 t
(If body to to be C
temp7.held,1111.1n'Race later)
i .
Cemetery ....40,...12. 1,./...41-14/- Cerr1-1 Date of Burial 419.-$.-..
tit'body la to be temporarily held,till in apace later)
Thn 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 Registerei
Number, d on the basis th .el HEREBY GRANT A PERMIT
to 7: (.1";--Ce.x.-. • -- e,:i(z.4 1- z/.
1 /
the ( (Address)
' ?aa..h-.-e.,-.2 .0-- to hold temporarily and ---t-t- --
the hod)
Da....._,._.(ErttIrtaker or person haying charge of corpse) (In more,or otherwise dianose of(state how))
•,-ur ...............,,f__-.777_,,, _.t.2
This Permit is sufficient for the 1R9...• :: (Signed)41.2,4••••
cemetery. or other regulations),unless ree min"eall Local Registrar
Meet to loe
Owl Interment or Cremation) of a body to iny pet of the 5teta (fiL-ii:od,
° is kr common carni",in which we a Transit Permit (VS NJ, OP ig ""
_____.
ENDORSEMENT OF SEXTON OR PERSON IN C1.ARGE OF
PREMISES ON WHICH INTERMENTS p&ii 4
c__. -CREMATIONS ARE M DEctftik.
9 -34
Date o , r� was.._ 1
rlment� �)
(Name of Cemetery,C matorium, etc
Section .-_A Lot o. _ (pGrave Ne
� �, / <N�
(Signed). . 1�<�ks� -^ .....- C' (f .
(Person in charge) thin
Person in charge must return this Permit to Registrar of his 1)is UNDER-
SEVEN (7) DAYS from above date. If no person is in charge, tileface of the
TAKER MUST SIGN ABOVE STATEMENT, write across the WITH
Permit the words "No person in charge," and FILE PERMIT IN
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
allr not
whose death occurs in this state or which shall be found dead thereinsed of or
be interred, deposited in a vault or tomb, cremated or otherwise disposed
removed from or into any registration district, or be temporarily heldermit for
further disposition more than seventy-two hours after death unless a Pr t the
burial, removal,or other disposition thereof shall have been properly issuedoccurred
registrar of vital statistics of the registration district in which the death
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 (lead of r
is transported from outside of the state into a registration district in this d health
burial, the transit or removal permit issued in accordance with the law at a force
regulations of the place where the death occurred shall be given the sam
and effect as the burial permit herein provides.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. having
§ 379. Duties of undertaker. In each case the undertaker, or person rie dis-
charge of the corpse,shall file the certificate of death with the registrar of trier to
trict in which the death occurred and obtain a burial or removal permit P er to
any disposition of the body. * * * The undertaker shall deliver the burial P.. on-
to the person in charge of the place of burial, before interring or otherwise disp
ing of the body; or shall attach the removal permit to the box containirlls the
nY
corpse, when shipped by any transportation company; said permit to acco all be
the corpse to its destination, where if within the state of New York, it sh
delivered to the person in charge of the place of burial. r
ii nte -
§ 381. Interments. No person in charge of any premises on which -
nents or cremations are made shall inter or permit the interment or other cil is
ition of any body unless it is accompanied by a burial,cremation or transit Pe I.tit-
s herein provided. Such person shall endorse upon the permit, the date of i =-itd to
sent, or cremation over his signature, and shall return all permits so endorse
cre-
e-
le registrar of his district within seven days from the date of intermen t or on
cation. He shall keep a record of all bodies interred or otherwise disposed �'f
to premises under his charge, in each case stating the name of each deceased
arson, place of death, date of burial or disposal, and name and address Of.,. the
ed
idertaker; which record shall at all times be open to official inspection: prof'= day
at the undertaker or person having charge of the corpse, when burying a1 .rial
a cemetery or burial ground having no person in charge, shall sign the -the
removal permit, giving the date of burial, and shall write across the face c'f
rmit the words "No person in charge," and file the burial or removal 1jerr-alit
thin three days with the registrar of the district in which the cemetery is lvcatd,
SEXTONS and UNDERTAKERS violating the law relative to the return �f P—ta
s are liable to a penalty of NOT LESS THAN FIVE DOLLARS 1Tt
AN FIFTY DOLLARS FOR THE FIRwr rs.-..-----