Clingman, Violet Ferns VS.IL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
sr This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Tatra,
Village, or City) in which the death occurred after the FILING and accep a CO CT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INIL _
Town Registered No...................................
Village
Dist. No`-W":Count) .211.4.."-N..
... .. ..... ..... .
//// . . (If city, give eet address)
Name of decease L-• Veteran
�ingle married, wid (If an. ' e name of wsr)
S Color... ... r divorced wri a the word Z-- ..19 S'y
• ....Date of a
Age ..5-7 Yea Months s ..... ys Birthp c .._. . ... 12:1......44,
Cause of Death.. ,
.. . . . . .
Certificate was signed by.... t.,._ ,„ :1.4.0.:..,k" M.D.
Address x c
Place of Burial (or emoval) „- -(— 1•1,4-e.4..'—
(If body is to be temp I eld,fill 1 e later
Cemetery .. 1. .. Date of Burial.. . ,,t' — y 19. s y
(If body is to be to orarily held,fill in space later)
Tim 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 ac pted same for registration, have recorded it in my Local Record with the above stated Registered
No um and the=he,.._.II HEREBY GRANT A PERMIT e ,
t
ame) p dress)
the . .. . . . . . to hold temporarily and cai"yt, the body.
(Unfit rtaker or person having charge of corpse) ter, remove,o o erwise dispose of[state bow])
Dated.... �t.��' ',,. 19 -`' (Signed) .......
s Local R ��---
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any peat of the State (subject to local
cemetery or other regulations),unless removal is by common currier, in which case a Transit Permit (VS No. 62) is required.
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE C
PREMISES ON WHICH INTERMENTS Olat--4
REMATIO S ARE MAD y
D f_ '9
_ _ was- -- •-- 1 19
e - en or crema
—1(;,E7
(Name of Cemetery,Crem n n, et '�
y,}Section._ o __ Lo o. Grave No '
(Signed) , 1`�o-A4es__) '
(Person in charge)
Person in charge must return this Permit to Registrar of his District with
SEVEN (7) DAYS from above date. If no person is in charge, the UNDE:
TAKER MUST SIGN ABOVE STATEMENT, write across the face of t
Permit the words "No person in charge," and FILE PERMIT WITHI
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 pers,
whose death occurs in this state or which shall be found dead therein shall n
be interred, deposited in a vault or tomb, cremated or otherwise disposed of
removed from or into any registration district, or be temporarily held pendii
further disposition more than seventy-two hours after death unless a permit f
burial, removal, or other disposition thereof shall have been properly issued by t
registrar of vital statistics of the registration district in which the death occurr
or the body was found. No such burial or removal permit shall be issued by al
registrar until, wherever practicable, a complete and satisfactory certificate
death has been filed with him as heretofore provided; * * *. When a dead bo,
is transported from outside of the state into a registration district in this state f
burial, the transit or removal permit issued in accordance with the law and heal
regulations of the place where the death occurred shall be given the same for
and effect as the burial permit herein urovided for. No registrar of vital statisti
shall receive any fee for the issuance kif burial or removal permits under this a
other than the compensation provided in this article. Provided, however, that t
state commissioner of health shall have power to promulgate rules with referen
to the removal of bodies of persons whose deaths occur on trains, boats or oth
carriers engaged in the transportation of persons within this state.
§ 379. Duties of undertaker. In each case the undertaker, or person havii
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
any disposition of the body. * * * Tl e undertaker shall deliver the burial pern
to the person in charge of the place of burial, before interring or otherwise dispc
ing of the body; or shall attach the removal permit to the box containing tl
corpse, when shipped by any transportation company; said permit to accompai
the corpse to its destination, where if within the state of New York, it shall
delivered to the person in charge of the place of burial.
§ 381. Interments. No person in charge of any premises on which rote
ments or cremations are made shall inter or permit the interment or other disp
sition of any body unless it is accompa(hied by a burial,cremation or transit perm
as herein provided. Such person shall;endorse upon the permit, the date of inte
ment, or cremation over his signature;and shall return all permits so endorsed
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 c
the premises under his charge, in each case stating the name of each deceas,
person, place of death, elate of burial or disposal, and name and address of tl
undertaker; which record shall at all times be open to official inspection; provid,
that the undertaker or person having charge of the corpse, when burying a bot
in a cemetery or burial ground having no person in charge, shall sign the burl
or removal permit, giving the date of burial, and shall write,across the face of tl
permit the words "No person in che.rge," and file the burial or removal perrr
within three days with the registrar o, the district in which the cemetery is locate
SEXTONS and UNDERTAKERS violating the law relative torthe return of pe
mits are liable to a penalty of NOT LESS THAN FIVE DOLLARS NOR MOR
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforce