Burial Permitq
--------- STATE OF MINNESOTA—.
Township------ - og _� REGISTRAR'S v
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city Permit f M r
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D of i7eeplit----------
7
Full flame_-- -- -
-------- -- -- -- --------Age ----_Yrs.
Disease causing death- - --- -------- ----------------------
{
Medica I I roposed date of
attendant
J� IF Worr Val) -
Place of Burial
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via
Place of reo}hveL= n� — — -------�-Z7- -- --------
A certificate of death having been fil y office iA acco with the lyws
of Minnesota, I hereby authorize the ..... .. .. ............ .........of the body
(Burial or Romoraq
of said deceased person as stated above. In the case of death from a dangerous com-
municable disease, the burial or re vo te's be Vduc_ according to the rules of
the State and local boards
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-------- + _ ----- ---
O®Ciel Title
"Removal" as ov cave may be. ]burial permits mage be elvers
A Sexton- Removel permits must be elven m the Agent o Trams
wd rdn -' ed by mn to box ad"IAcontaining body. Embalmer
lscrarg wa
words "Registrar of or iravr and Licensed Embalmer for b be
of Llcenae. F9ae or imprisonment for receiving a body for Darla
NOTICE TO UNDERTAKEBS.
This blank constitutes a Registrar's "Burial Permit" or "Removal Permit," accord-
ing to the manner in which it is filled out by the Registrar.
As a Registrars Burial Permit, it must be obtained by the undertaker before any
disposition is made of the body. It is the duty of the undertaker to have a certificate
of death properly filled out with the personal and statistical facts required by law, to
present it to the attending physician for his certificate of cause of death, and then to
file the completed certificate of death with the Registrar of the district where the
death occurred. Sextons should not permit the interment of a body "accompanied
by a regular Burial or Removal Permit.
As a Registrar's Removal Permit, this blank must be obtained from the Registrar
as above, presented by the undertaker to the Agent of the Transportation Company,
and be attached by the latter to the box containing the body. The Removal Permit
is not a Transit permit. The latter, supplied to undertakers by the State board of
health, provides for a statement of the proper preparation of the body for transporta-
tion, signed by the Health Officer, and contains Removal Permit. No transit permit
can be issued by any health officer or accepted by the agent of any transportation
company in Minnesota unless a Registrar's Removal Permitformspart of .t or has
previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUBBEGISTRARS.
A licensed embalmer, holding an unrevoked certificate of authority from the State
Board of Health to act as subregistrar of deaths, can use this blank for the issue of a
permit for burial or removal to himself for a death occurring in a township or vil-
lage, but not city, under the same restrictions as those governing its issue by a reg-
istrar. The certificate of death, fully made ont in ink, and signed by informant and
physician, must be in his possession before issue of permit, and the certificate must be
personally delivered to the registrar of the township or village where death occurred
on or before the third (3rd) dac of the following month without fail.