Loading...
Strempel, Edward V UI tncv. II ia) IVCW T VII OId1C UCpdILI1IClll VI r1 dIUl BURIAL — TRANSIT PERMIT Name:First_ci yieSex Date of Dea Age If Veteran of U.S.Armed�r6es,W r D tes I—, //-1/-es 6/ - //J./C/_ Z Place f e the City,Town or Villa p tal, In t on Street Addres 4.1 W au s f the fU �A�ifier g,pp/��� 7/1�? A ed1 I ertifier: N itle ress e erti 1c i e : 1 ,To or Village Tstrict No. ��Register No. Burial: Date /� 6_rp Cemet or Cremato Address ' , ry ✓ El Cremation:Z '� " Removal Date Place Removed and r Held Address C ❑ and/or Hold: E-, ril Date Point of Shipment Destination p Transportation by ON ❑ Common Carrier: rn A Date Cemetary Address Disinterment: 0 Reinterment: Permit Issued To:Name of Funeral Firm Address . Registration No. Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other Than Above: ©/ EH Ad, ess: ��• if //, y 9 fat �b p f .tr.Q-? '/.3� �� /jL./J � /�li - et."---4y - 04 F-rmission is h: -b" ranted t dis o the dead human remains described above s indlcat a Date Issued //—S- �G. �� eg strar of Vital Stat. s (Signature) District No S4 / . Place 4Q his permit must be completed on back by the person in charge at the place of dispositidrfan iI with the registrar of vital statistics o e city,town or village where disposition took place. PUBLIC HEALTH LAW §4145. Deaths; burial and removal permits; disposition of remains. 1.No person in charge of any premises on which interments,cremations or other disposition of the body of a deceased person are made shall inter or permit the interment or other disposition of any body unless it is accompanied Joy a burial,cremation or transit permit,as provided in this article. 2.The funeral director or undertaker shall deliver the burial permit to the person in charge of the place of burial or other disposition,before interring or otherwise disposing of the body;or shall attach the removal or transit permit to the box containing the body,when shipped by any transportation company,which permit shall accompany the remains to its destination,where if within this state,it shall be delivered to the person in charge of the place of burial or other disposition. 3.The person in charge of the place of burial or other disposition shall endorse upon the permit,the date of interment,or cremation or other disposition over his signature, and shall return all permits so endorsed to the registrar of his district within seven days after the date of interment, cremation or other disposition. 4.When burying or otherwise disposing of the body of a deceased person in a cemetery or burial place having no person in charge,the funeral director or undertaker shall(a)sign the burial or removal permit,giving the date of burial;(b)write across the face of the permit the words"No person in charge;"and(c)file the burial or removal permit within three days with the registrar of the district in which the cemetery is located. 5.The person in charge of the place of burial,cremation,or other disposition 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 funeral director or undertaker, which record shall at all times be open to official inspection. ENDORSEMENT OF SECTON OR PERSON IN CHARGE OF PREMISES. 7rDate) I certify that the remains were disposed of in accordance with the permit on the reverse side on ///‘ C, at J C i'.� r y G r CVrt L l G Y•. h 3 j y /f (Place of disposition and add ss) Section Lot No. Grave No. Signature Title