Burial Permitnor �..z
STATE OF MINNESOTA
rownsAiµ_REGISTRAR'S _G��(�
MAW----`- ------- Permit r Burial or Removal
D or De 1
Full fVame__—L-7ir/L A9ey,�
Disease causing death _:__ _ __ _____
----- --- -- - -- - ----- -------
Medica I l?,,� � � Proposed date of
attendant 1/'��C-4 _ lorremoval
Place of Burial - --
---------- - - - - -----------------------
- -- - ----------- - ---
Place of remov ----- --------- via
-___--
-- ---- ------
Undertaker ----_- Address-------------
-- -- ---- --- ------ - ---------------- --------
A c tate of death having been y office in hccordan a larva
of Minn ota, I It authorize the....�%...... ...... ...of the body
of said deceased person as stated above In the case oadeatthh all,
a dangerous cam-
municable disease, the burial orr removal trst,be a ac co g to the rutes of
the State a boards of he;
._�
---- -- - - Lbealven
---------'--------
----- ---
ial Title4rlte "Burlat" r "Removal"the case may be. permits m be delivered
by ilia Undertaker to the Sexton. Removal permits must to the t of Trans-
portation Company, and attached by him to box Containing body. Subregistrars win
ante "Sub" before the words "Registrar of Deatba" and Licensed Embalmer Na—" be-
low Fy
always giving N. of License. Fyne or Imprisonment for receiving a body for burial
wltlrout a permit
NOTICE TO UNDERTAKERS.
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 arty
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 imertuent 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'TransportaBon 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 Permit forms part of it or has
previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUBREGISTRABS.
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, most 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 [he third Ord) dac of the following month without fail.