Jackson, Thelma 1 _ The A
Legal Foe For This Permit Is $1.00 FR.era • y°Y
�oei
BURIAL, CREMATION OR REMOVAL PERMIT It f
STATE OF NEW JERSEY o `
V
RIDGEWOOD SEPT. 15 19 87 o e `o E
(City,borough or township) (Date) �y... c'.
�•a `
"SHE E j S
The Certificate of Death having been file} ith me as regiri4,44 by the laws of this State, permission is C 0 C
hereby given for the removal, burial, cre c> eonA er i�ss!Yt of the body of I._ 21
M
t� ik p, 13 87 2 ❑AM s"
73 F 5 E 1.
age sex , who died ink t .. F �r. oe ,; 19 at �7PM � ;o
SEPS If (,E V O Cause of Death a .;,,`. .si v c ., P.�c
Proposed Place of Removal,Burial, mati•o-�n,ivri r 4 ' -�c
other Final Disposition Pam.. E7/Y ,/��+' .y"'"'.•. .. . ...CO...Q S BERM,'N.Y. 17.,R h.
r.,
Place l 1,, I • . 4 LocAtiOf N x
Funeral Director " , E' i
John Kukal #3695 r txrY,.N £ITl. : y ill
C.C. Van urgh'Inc. �1
Ridgewood).-p,7 T tz� .. 0 8
(Address) eCIP egistrar of Vital Statistics) +,-
" J
H-3259 Penalty For Burying Without a Permit, $5 ;a10 to$100 I
STATE OF NEW JERSEY
+ BURIAL,CREMATION,OR
REMOVAL PERMIT
State law requires that no person shall cremate a dead
human body unless at least 24 hours have elapsed from
time of death listed on death record.
(Name ofDeceased)
c ., .....1..8...`.. `:.......1 & 7
(Date of Burial)
atI.... 0 QPM
(Date and Time of Cremation)_f
(Si ture of Superin ndent of Cemetary or Crematorium)
This permit must be delivered to the)skip r ritendent of
the cemetery or crematorium where burial or cremation is to
take place, who should fill in the spaces above and forward
it within ten days to the registrar,of the,district in which
the cemetery or crematorium is located. Registrars are usually
health officers, city and borough;Clerks and assessors of
townships.
1i }
When burial takes places in a cemetery which has no
person in charge, the spaces above should be filled in by
the funeral director, who should write "no person in
charge" on the line for signature of superintendent of
cemetery and file the permit with the registrar of the dis-
trict in which the cemetery is located. The law rewires
that this be done within ten days after burial.