Burial PermitLor
STATE OF MINNESOTA 6 `
— N WMILSTRARIS
Wle
M_.
Per
city efrfoval
city-- ------------------
W B I or
4---
Date of h -- -------- ---------- 190-----
Full gam_ v
e
-------
------------------- -----------
yrs.
Disease causing death --- - ---------------_--
Proposed do
----------------
Medical l ate f zo
attendant J__-_ burial orremeval}-_ _
70
Place of Burial_ �__� .
------ - ----
Ptace of remo-4---- --------------- ---- Na------ ---- -----------
h_____.__ -__-._-_---__._._-___--_-_____—_
_
A W.of death having bem file�il my office in accor a with the laws
Of M' esota, I here authorize the ...:.. ... ................. ......of the body
tsarist or sea o.an
of said deceased
person as stated above In the ase of death from a daWxous com-
municable disease,the burial or reme ��e/ � c� ducted acco g
n to the rules of
the State and lol boards of health(.
t br pmam.l
Dated --7-- -_ -----'----
O®clal Title
•Write 'Burial" or"
Removal' m the case may be. Burial permits must be delivered
by the Undertaker to the Sexton. Removal permits most be given to the Agent of Trans-
don
ratls-
erars will
n Sub" before then wordss"Registed rarlm to box of Deaths' and "'bossed Embalmer Ko. ^ be-
low, always giving No. of License. Fine or imprisonment for receiving a body for burial
without a permit.
NOTICE TO
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 Registrar's 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 unaccompanied
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
—Gealth. provides for a statement of the proper preparation of the body for transtwrtn-
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 Permit forms part of it or has
previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SQBR.EGISTRAR&
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 out 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) day of the following month without fail.