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Barber, Anna Fero- is.aL NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT to 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 CERTIF1CA3E/OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Town Registered No.__-. --.....1 � n Village Dist. No..d. '-- County...., or City (If city, give street address) Name of deceased &.:3e:21.a, X e1r►�?i Q/ Veteran k440. �j �'+ p �� Single, married, widowed, (If ve ern. give name of War) p Sex Trr• Color.1Q C..4nr divorced (write the word)... .���e�L Date o eath.... ..$� • O! 19.70.. Age Ctl- Years. . ,...Mo the Days Birthplac Liti •Cause of Death .M..6 Q, Certificate was signed b . G7 M.D. ...... . . .... . ...... . .. . . Address Place of Burial (or Removal) ,,1—cite . • „. .,.. ,,,, . (If body is to be temporarily held, fill In space later) Cemetery Date of Burial 19 (It body is to be temporarily held,fill in space later) The 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 Registered Nu n the b sis .ereof I H l ' Y G NT PE IT to. )2-y /‘,1.4) (Na • ddress) the me .........to hold temporarily and the body. ( d r er or person having chargerof copse) (Inter,remo�"dr o se !.Dose of to how]) Dated........ . .- ,---,/ 19..,' (Signed) / .e. Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the Mats (subject to local cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF ‘"' PREMISES ON WHICH INTENTS OR CREMATIONS ARE MADE Date of j('1..✓cam c•,,,i) was -;'t t Clg 7 (Interment or Cremation)(/ ( 1 Y vc C C f Ct�— (Name of Cemetery, Crematorium, etc.) I/ Section /" - - L=-" Lot No. Grave No. (Signed) / �'` - ,4--c -yam - (7- (Person in charge) Address / ��z e it- Person in charge must return this Permit to the Registrar of his District within SEVEN (7) DAYS from above date. If no person is in charge, the FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATE- MENT, write across the face of the Permit the words "No person in charge," and flLE PERMIT WITHIN THREE (3) DAYS with the Registrar of District in which cemetery is located. SEXTONS, FUNERAL DIRECTORS 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 re- quired, under penalty, to report violations thereof. Form VS No. 62. 3-28-49-10M (8C-487) TRANSIT PERMIT NEW YORE STATE DEPARTMENT OF HEALTH ALBANY il' A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accom- pany each dead body transported by a common carrier.—Regulation 1, subdivision 1. UNDERTAKER'S CERTIFICATE -- I rrrhg tllrritfg that the accompanying dead body of Rana.1_fl . . ., .lax 5.C-Q. x Veteran* nD who died in the LC LY of , (If veteran, give name of War) (City, Village or Town) Countyof C+IQ1.t4...a State of New York, on Q �j$ Singles r -e�.• -L 19.__{., SeX___ ' crowed ,p `•` " S Divorced � Color or ra e . \ t4 .-.-_--,Age... 2 years months days, Birthplace.__l--1)..'x£(...4'... and Cause of atDeath a. g.-' _-_C_Q.Ct si.LD.N has been prepared for transportation ^a strictly in accordance with Regulation 1, subdivision {� as printed with this blank. Certificate was signed by .3 ._. RANK_.. .�'1t1►._Q irO , M.D., Address__t,�(R�°. .R.0 '1gDate of shipment..Dec• 4 30,.. .Ia 19 ; Route of shipments A f"' rn,/`►LI 1 r ; Point of shipment 1�i. *.X' LI -_�11A iq ; Point of destination i`1l_b1�_A}A,{-_ -.1��1..-. • (Signature of Undertaker) .---- c y N cp Dated - lG• 1 1921 Address__ ._ 1 -�o_.Gt44... _--,a A.-_a {iS.y- 3 °Cross out words not applying �J PERMIT OF LOCAL REGISTRAR <1 DIST. No. ,-' /- Registered No. - Li Date of issuance &cc. c 1 19.. __�T A satisfactory Certificate of Death for above decedent having been filed and recorded in my office, PERMISSION IS HEREBY GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY,, Local Registra ) 6 /u—IL�P��/� _ �1 Local Registrar of the " -,!/ of -. , County of C1 c Ct— (City,Village or Town) �. State of New York. ,_ = Only the Local Registrar (Deputy or Subregistrar) may issue a Burial, Removal or Transit Permit i 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 Date of was 19...... (Interment or Cremation) (Signed) Person in charge of (Name of Cemetery,Crematorium, etc.) 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 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 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 dispose otherwise of the body, stating the name, age, sex, cause of death and other neces- sary 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. attacn part oeiow to outer oox or case Form VS No. 62. TRANSIT LABEL 3-28-49-1OM (8C-487) NEW YORK STATE DEPARTMENT OF HEALTH ALBANY A Transit Permit and Transit Label issued by the Local Registrar of Vital Statistics must accom- pany each dead body transported by a common carrier.—Regulation 1, subdivision 1. PERMIT OF LOCAL REGISTRAR DIST. No... :../>' Registered No c.t. LI Date of issuance n 19 A satisfactory Certificate of Death having been filed and recorded in my office for 1?1�/.1.a 2 Qark. .r- .m , who died in the �iDlry J'1 of �1..�`rmi (City, Village or Town) D ' County of e M.• , State of New York, on I.3' - sl~?4 19_7.q and a) the body having been prepared strictly in accordance with Regulation 1, subdivision , as certified by__/ _/ nn`` (Name and s. era/._-!!_. Shipping Undertaker, PERMISSION IS HEREBY GRANTED 'b a dress of Shipping Undertaker) w FOR THE REMOVAL AND SHIPMENT OF THE BODY OF SAID DECEDENT; Name of consigneeescoTt ; Point of shipment .gf./../lc.il.? ; Point of 4e�BAN7 OO�v destination / /v-1_ /c cp (Signature of Local Registrar) t l/ a) Local Registrar of the 1---em s of- ✓(�f , County of L'.���1-(.42 � _..., w __ •P (City, Village or Town) • State of New York. ce 0 ROUTING d The Railroad or other Transportation Agent must enter hereon a description of the tickets held by the passenger in charge of the corpse, the exact route, and VIA WHAT JUNCTIONAL POINTS it reads. SPECIAL INSTRUCTIONS—A burial case containing a corpse must not be received for transportation unless the person in charge presents a Transit Permit issued by the Local Registrar of Vital Statistics (Regulation 1, subdivision 1), and an Undertaker's Certificate stating that the body has been prepared for shipment in accordance with the Laws of the State, nor should it be received even then if any fluids or offensive odors are escaping from the case. Date 19 From State of New York,to State of No. of Escort's Ticket Form No. of Escort's Ticket No. of Corpse Ticket Form No. of Corpse Ticket Via To Via To Via To Name of Passenger in charge Place of Residence Signed Shipping Agent. NEW YORK STATE DEPARTMENT OF HEALTH ALBANY 1 TRANSPORTATION OF DEAD BODIES BY COMMON CARRIERS (Chapter XIII. The Sanitary Code in effect throughout the State of New York, except in the City of New York.) Regulation 1. Transportation of dead bodies by common carriers. The transportation of dead human bodies by com- mon carriers shall be conducted in such manner as not to be a menace to health and shall conform to the following require- ments: (1) A transit permit and transit label issued by the local registrar of vital statistics must accompany each dead body transported by a common carrier. The transit permit shall state the date of issuance, the name, sex, race and age of the deceased, and the cause and date of death. The transit permit shall also state the date and route of shipment, the point of shipment and destina- tion, the method of preparation of the body, and shall bear the signature of the undertaker and the signature and official title of the officer issuing the permit. The transit label shall state the date of issuance, the name of the deceased, the place and date of death, the name of the escort or consignee, the point of shipment and destination; and shall bear the signature and official title of the officer who issued the transit permit. The transit label shall be attached to the outer box or case. (2) The transportation by common carriers of bodies dead of any diseases other than those mentioned in sub- division 3 shall be permitted only under the following conditions: (a) The coffin or casket shall be encased in a strong outer box made of good sound lumber, not less than % of an inch thick. All joints shall be securely put together and the box tightly closed. Either the coffin or casket, or the outer box or case, shall be watertight. Every outside case holding any dead body offered for transportation by common car- rier shall bear at least four handles and when over 5 feet 6 inches in length, shall bear six handles. (b) When the destination cannot be reached within 60 hours after death, all body orifices shall be closed with absorbent cotton and the body placed at once in a coffin or casket which shall be immediately closed and the coffin or casket shall be prepared as indicated in subdivision (2-a) of this regulation. (3) The transportation by common carrier of bodies dead of smallpox, plague, Asiatic cholera, typhus fever, diph- theria (membranous croup, diphtheritic sore throat), scarlet fever (scarlet rash, scarlatina), shall be permitted only under the following conditions: All body orifices shall be closed with absorbent cotton, the body shall be enveloped in a sheet saturated with an ef- fective disinfecting fluid and shall be placed at once in a coffin which shall be immediately and permanently closed. The coffin or casket shall be prepared as indicated in subdivision (2-a) of this regulation. (4) No dead bodies shall be disinterred for transportation by common carrier, or for removal to another ceme- tery in the same registration district, or in another district, but not requiring shipment by common carrier, without the previous consent of authorities having jurisdiction at the place of disinterment. The undertaker shall make a request to disinter the body on a form provided for the purpose. This form shall provide for a statement of principal facts concerning the decedent, whether body is to be transported by common car- rier or otherwise, final disposition of same, and approval of health officer. Upon receipt of such request the local reg- istrar shall issue a transit permit and transit label as required by subdivision (1) and the provisions of subdivision (2-a) shall apply. (5) Notwithstanding any other provisions of this chapter, dead human bodies, prepared for shipment by the War Department of the United States in accordance with the repatriation program, may be accepted by common carriers for shipment to places designated by that department. Under the authority of a Basic Health Permit issued by the War Department the registrar of vital statistics of the district to which such a dead human body has been transported shall issue a permit for the burial, removal or other disposition of the dead body. The permit shall be made out as completely as possible on the basis of the information available.