Tieral, Jane Form VS.AL NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
e'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 ..
Dist No 3294 ONEIDA Village
Registered No.�..__ _ .:.
County...., or City MARCY
(If city, givr street address)
Name of deceased.... .Q!hQ� Veteran �Q
(if veteran,
�••• Single, married, widowed, give name of War)
Seaga ni.i.e....Color.uli►.�t••sr..•or divorced (write the word 401e.� //
Age 7 q Years ,� �' ��••�* Date of Death /�' � � 19�C�
.•M nths .• •...y$ Birtllplace' .G7rst
Cause of Death.. f
Certificate was signed by frgi a.-. a.•t `� • M.D.
Address /$ r / Y
Place of Burial (or Removal). •9
I body is to be temporetSyp)yg)d,81,]/Ia'�Dsce later
Cemetery t/,tf.. ...�!'„rs,r .c•a-, (•...•-..•• Date of Burial // �-? 19 c.is
If body is to be temporarily held, fill in space later)
rhn Certificate of Death containing the above stated particulars, having been present d to me, after careful exami-
lation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
have ted a ,for registration have recorded it in my Local Record with the above stated Registered
'gum andiesLA thereof I HER Y GRANT A PERMIT
v iAlame) d�'
he to hold temporaril and �1 (edge.?
(Un ertaker or person having charge of corpse) """" ' the body.
)ated (Inter,re ore,or othe dispose of[state how])
19 (Signed).. .. -s7� / e _
This Permit is sufficient for the Removalon) oa Local Registrar _
smetery or other regulations),unless removal is bycommon carrrier,einawh which case a Transit Permit (VS No.62)is required.b local
ENDORSEMENT OF SEXTON OK PKK5UN IN l4rtlt.tctx.e. yr
PREMISES ON WHICH INTERMENTS OR co„,,,,,
_ CREMATIONS ARE MADE �-
Date o __� i t.et 4% { was_` GZf ---19
(Inter t ) i r
1174
j ,,
Section �(7 °�Ceautery,Crematorium,
Lot�No,eY c.
Gd "1_ ave No
(Signed)--- -- ?4, - L ..,--- �2 ✓
(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 char-;a, the UNDER-
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 cem:,o,y is located.
EXTRACTS OF THE VITAL STATISTICS LAW
§ 375. Permits for burial or removal of dead bodies. The'body of any person
whose death occurs in this state or which shall be found dead therein shall not
be interred, deposited in a vault or tomb, cremated or otherwise^ disposedi of or
,jr,ss�.<, pvt,,.f.,„0,x -t, 'Mr .-.7i.tro4i�n .ii trirf�n- i..a.tp"' -'' ,51eid...pertdinyz..,,..__
further disposition'6ore than seventy-two hours after death un,ess a permit for
burial, removal, or other disposition thereof shall have been properly issued by the
'registrar of vital statistics of the registration 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 heretofore provided; * * *. When a dead body
is transported from outside of the state into a registration district in this state for
burial, the transit or removal permit issued in accordance with the law and health
regulations of the place where the death occurred shall be given the same force
and effect as the burial permit herein provided for. No registrar of vital statistics
shall receive any fee for the issuance of burial or removal permits under this act
other than the comfensation provided in this article. Provided, however, that the
state commissioner Df 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.
§ 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 dis-
trict in which the death occurred and obtain a burial or removal permit prior to
any disposition of tie body. * * * The undertaker shall deliver the burial permit
to the person in charge of the place of burial, before interring or otherwise dispos-
ing 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 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 intermer..t or other dispo-
sitip.of any.bodv xn e s it is gscomn�ltied by a burial.crematioppr transt permit.
as herein provider. Su'. person shall'endorse upon the per rift, he raitei t inter-
ment, or cremation over his signature, and shall return all perrriirs 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 acrpss 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.
Local Registrars, are required, under penalty, to report violations thereof.