Disposition Permit_ xa-�
County.-�� `� STATE OF MINNESOTA
TawenAip_�_ _Y,�,�e �� REGNTRAR'S
YiJ/aga.-----------\------'--}�.
Permi}f��rppB��urialgo�r R o I s�
efy--------------=--------------- �'�'ri=--AC1/ Is�oC
i /L --
------------
, tie of Death-_----- _
Full Name_y .'( :fit e&c rz,�1�30i-
Disease causing death -----------------
-------- K_�Cjnj t t��
Medial l' Proposed date
attendant
r
Place of Burial_,,____ _
-- ---------�-
Place of removal_________
Undertaker----------- -----------------_-----__ Address---
-------------- ----- -
A certificate of death having been
(,/�e(� in my office,
of Minnesota, I hereby authorize the..... ..:"�`�-..^,
(Burial or Hod
of said deceased person as stated above. In the case of d
municable disease, the burial or removal inipst-liacondueb
the State and local boards of health.
_ _eve of
-write "Burial" or "Removal' as the rase may be. Bu,
by the Undertaker to the Sexton. Removai perm[[, must be
poriation Company, and attached by him to box contains,
write "Sub" before the words "Registrar of Deaths" and"IJ,
low, always giving No. of 1,1 a Fine or imprisonment i
without a permit
--------- -
--------------- ---------------
n rdance with the laws
.. ........... of the body
Koval
,th f a dangerous com-
d according to the rules of
a
NOTICE TO UNDERTAj&_A
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 hiscertificateof 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 most 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 Permit forms part 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 out in ink, and signed by informant and
physician, must he 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.