Burial Permit.400.3
1 1 .
1a�
u `L. In-
Disease
n
Disease causing
Medical L_
Place of burial,
Name of cemel
This permit serves for s bu
meryrial permit at destination
except where local ordinance requires local permit.
STATE OF MIITNESOTA
REGISTRAR'S]
No. 644
or
A cetiificate of death &A been f eI in
laws of Bdlnnesota, I hereby authorlm the
body of deceased person as stated above. In case
municable disease, the burial or removal must be
of the state and local board of health_^. _ I
i
for Burial or Removal
date of
yrs -
with the
—of the
rain a dangerous Com -
according to the rules
official Title
*Write "Burin" or "Removal" as the ease may be. Burial permits must be delivered by the
undertaker to the aenton. Removal permits must be gtvea to the agent of transportation cam.
pany, and attacbed by him to bas contammg body Sob -registrar will write "Sub" before the
words 'Registrar of Deaths" and 'Licensrd Embalmer No. , below, always giv-
ing number of IIeense. Fine or imprisonment for receiving a—moo —y oorr 6nnal without permit.
Received 19 Sexton
Name of cemetery _Address
764 form may be umd for dlelatammt-rmtermmt in accordanne with Regulation a