Burial Permit`_or `'.3
cowrty_L_- - STATE OF MINNESOTA
rowneni --� - RE(3ISTRAEts
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NOW
Yi!lage - _ _ _
Per der Buriahor�jt
circ ------------ ,
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Deft- 197_.
Full Name
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--
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Disease causing deatY--------_- ---- - — ----- ------
Medica I 1 �'�� Proposed date of c7 I
attendant J _-- - -- --- --K c ^ rtal oremoval �4 tS/
Place of Buri a t-
Place of removal :, -- - ----- ---------
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Undertaker-
A rwrtificate of death having been filespin my office in accordance withithe laws
i .r
of Minnesota, I hereby authorize the.... s...,%'�-Ll/�^w�'... .......... of the body
(Bartel m HomOMli
of said deceased person as stated above.- In a rase of deathli o a dangerous con-
i municable disease, the burial or removal my ,`eogilu ed according to the rules of
the to and loeal boards o"ealthh.
--�- 1. ---.-1-------
O®alal Tule
i
*write "Burial" t 'Re on- ea the ease mal be. Aerial n to th must f T ft as
M the Vndertaker to the 8ettnd- Removal nermtts moat be given to the Agent f TA➢►
a
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 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
bya 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 trauspurta-
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 SUBREGISTRARS.
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 asthose 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 most be
personally delivered to the registrar of the township or village where death occurred
on or before the third Ord) day of the following monthwithout fail.