Olson, Mark Form VS No.68. 3 26.53-iOM(2C-226)
TRANSIT PERMIT
NEW YORK
STATE DEPARTMENT OF HEALTH
ALBANY
mir A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accompany
each dead body transported by a common carrier.—Regulation 1, subdivision 1.
UNDERTAKER'S ERTIFIC E "
3J Oerebp Cettifp that the accompanying dead body of > c�-�f `-�'
Veteran* who died in the V of ,
(If veteran,give name of War) (City,Village or wn)
'�'`� ^ Single*
MCounty of /1<lR. , State of New York,on -- (/ /y i . . Sex %j.( . WdnFricd
C Single d
D4R)°,ed
.� Color or race u?`L• Age// .1 years / months days, Birthplace 'bt arid Cause of
.a Death L G',': -tie. yu..D3s.[.s�i has been pr ared for transportation
,,S,
strictly in accorda a wijth Regu ti n 1,i subdivision / printed with this blank eft'sate was signed by J
1 y4G�A ' '4 M.D., Address 4� Zate oment / ..<?V 1�g
•e
19 , Route of shipment ,//� Point of
3 shipment ; Point of destin tion..l(11�r-t -4. / "�'�'4 ��.
.a
0 (Signature of Undertaker).6 h.t /V - .�
Dated.... ..... ... . y 19..7..`) Address �"
/ `Cross out words not applying.
PERMIT OF LOCAL REGISTRAR
DIST. No. 1 SI"r I Registered No. s ?
3 Date of issuance ) 1/1-O.-.7 )- 0 19.5 J
A satisfactory Certificate of Death for above decedent having been filed and recorded in office, PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF THE B Y.
(Signature of Local egistrar)... . ,
Local Registrar of the.... 1 of .. .. .. , Coufn of ,A..c_..4,
(City,Village or Town)
State of New York. ('
Dir Only the Local Registrar (Deputy or Subregistrar) may issue a Burial, Removal or Transit Permit
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of ... 2^ --• was E' - � 19C��
(Interment or Cremation) ( :.
n
(Name o ete , Cremators m, etc.)
` -- /- c2—�. t', Lot No."A A, Grave No Section , ... .
Signatur .. ..r�„�....�Gam " "�"t �`_ - �-- GG L? Cl ��
(Person in Charge) ( 'dress)
.," - T
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 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 ceme-
tery 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 certificate 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 transpor-
tation 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.
§ 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 dis-
pose otherwise of the body, stating the name, age, sex, cause of death and other necessary 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.
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.